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1.
J Infect ; 78(2): 127-133, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30267802

RESUMO

OBJECTIVES: To evaluate burden and predictors of HSV pneumonia among immunocompromised patients not undergoing invasive mechanical ventilation according to a tailored diagnostic algorithm. METHODS: This prospective, observational study included immunocompromised adults with pneumonia non-responding to empirical antibiotic therapy. Bronchoalveolar lavage (BAL) specimens were cultured for bacteria, mycobacteria and fungi. Real-time PCR for Herpesviruses and other microorganisms were performed on BAL and other specimens. Cytological examination of BAL samples was carried out for identification of intranuclear inclusion bodies and immunohistochemical staining for HSV. RESULTS: We enrolled 45 patients (mean age 64.6 years) from January 2015 to June 2016. Nineteen (42.2%) cases tested positive for HSV-1 PCR on BAL. According to our definitions, 11 (24.4%) patients had HSV-1 pneumonia with viral loads ranging between 103 copies/mL and 107 copies/mL. HSV-1 positive throat swab (OR 85.2, 95% CI 5.83-1245.1, P < 0.001) and solid organ transplant (SOT) (OR 53.3, 95% CI 1.37-2072.8, P < 0.03) as underlying condition were found to be independently associated with HSV pneumonia by multivariable analysis. CONCLUSIONS: HSV pneumonia turned out to be relatively common and should be investigated especially in individuals with HSV positive throat swab and SOT. Interventional studies are needed to assess the real clinical impact of HSV pneumonia in immunocompromised patients.


Assuntos
Hospedeiro Imunocomprometido , Pneumonia Viral/imunologia , Simplexvirus/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Líquido da Lavagem Broncoalveolar/virologia , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Carga Viral
2.
Infect Dis Health ; 23(1): 17-22, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-30479299

RESUMO

BACKGROUND: Imported malaria cases continue to occur in non-endemic regions among travellers returning from tropical and subtropical countries. At particular risk of acquiring malaria is the group of travellers identified as immigrants who return to their home country with the specific intent of visiting friends or relatives (VFRs) and who commonly believe they are immune to malaria and fail to seek pre-travel advice. Our aim was to review the current trends of imported malaria in the three main hospitals of the Friuli-Venezia Giulia region (FVG), North Eastern Italy, focusing in particular on patient characteristics and laboratory findings. METHODS: In this retrospective study, we examined all malaria cases among patients admitted from January 2010 through December 2014 to the emergency department of the three main hospitals located in FVG. RESULTS: During the 5-year study period from 2010 to 2014, there were a total of 140 patients with a diagnosis of suspected malaria and who received microscopic confirmation of malaria. The most common species identified was P. falciparum, in 96 of 140 cases (69%), followed by P. vivax (13%), P. ovale (4%), P. malariae (4%), and mixed infection (4%). The most common reason for travel was VFRs (54%), followed by work (17%), and recent immigration (15%). Moreover, 78% of all patients took no chemoprophylaxis, 80 (79%) of whom were foreigners. Notably, the percentage of Italian travellers who took chemoprophylaxis was only 20% (8 of 39 Italian cases), and the regimen was appropriate in only four cases. Parasitaemia greater than 5% was observed in 11 cases (10%), all due to P. falciparum infection. CONCLUSIONS: We highlight that VFRs have the highest proportion of malaria morbidity and the importance of improving patient management in this category. These data are useful for establishing appropriate malaria prevention measures and recommendations for international travellers.


Assuntos
Malária/epidemiologia , Viagem , Adolescente , Adulto , Idoso , Quimioprevenção , Criança , Feminino , Hospitais , Humanos , Itália/epidemiologia , Malária/etnologia , Malária/microbiologia , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/isolamento & purificação , Plasmodium vivax/isolamento & purificação , Estudos Retrospectivos , Medicina de Viagem , Adulto Jovem
3.
J Travel Med ; 25(1)2018 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635643

RESUMO

Background: In 2016, 362 753 migrants reached Europe by sea. Most of migrants come from high tuberculosis (TB) burden countries and travel in conditions that increase the risk for communicable diseases. The goal of WHO End TB Strategy is to end global epidemic by 2035. Management of latent TB infection (LTBI) in low TB incidence countries is thus essential. Nevertheless, a lack of uniformity in policies and procedures for LTBI screening in Europe is perceived. The aim of this study was to estimate the LTBI prevalence in migrants by Mediterranean Sea. Methods: A cross-sectional study was conducted, involving 1038 migrants. Since a gold standard method is not available, LTBI prevalence was assessed in four alternative scenarios with different thresholds and diagnostic tools: (i) TST ≥ 5 mm; (ii) TST ≥ 10 mm; (iii) TST ≥ 5 mm plus IGRA; and (iv) TST ≥ 10 mm plus IGRA. TST = tuberculin skin test; IGRA = interferon-gamma release assay. Results: The four scenarios returned the following prevalence: (i) TST ≥ 5 mm: 40%; (ii) TST ≥ 10 mm: 33%; (iii) TST ≥ 5 mm plus IGRA: 27%; and (iv) TST ≥ 10 mm plus IGRA: 25%. Moreover, a positive association was found between the proportion of IGRA positive patients and the size of TST induration site. No patient who reported TST ≥ 18 mm tested IGRA negative. Conclusions: Prevalence varied substantially in the investigated scenarios. Significant differences were noted according with the nationality of migrants, probably attributable to different Bacillus Calmette-Guérin vaccination coverage rates in the countries of origin or different exposition to non-tuberculous mycobacteria infection. Data about the nationality can suggest the need of a tailored approach according to migrants' area of origin.


Assuntos
Tuberculose Latente/etnologia , Programas de Rastreamento/métodos , Migrantes , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Testes de Liberação de Interferon-gama , Itália/epidemiologia , Masculino , Mar Mediterrâneo , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Teste Tuberculínico , Adulto Jovem
4.
Clin Exp Rheumatol ; 35(5): 752-765, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28516869

RESUMO

OBJECTIVES: Inflammatory arthritis needs infectious disease screening before starting a biologic agent, however, few data are known about migrant patients, who represent a peculiar population which requires a multidisciplinary approach among international health specialists and should also be considered by health authorities. For this reason, the Italian and Spanish Societies of Rheumatology (SIR and SER) and Tropical Medicine (SIMET and SEMTSI) promoted a multidisciplinary task force in order to produce specific recommendations about screening and advices to be considered in migrant patients with inflammatory arthritis candidate to receive biological therapy, according to their geographical origin. METHODS: The experts provided a prioritised list of research questions and the eligible spectrum of inflammatory arthritis, biologic drugs and infectious disease were defined in order to perform a systematic literature review. A search was made in Medline, Embase and Cochrane library, updated to March 2015. Ubiquitous infections and HBV, HCV, HIV and tuberculosis that are already considered in national and international recommendations, were not included. The strength of each recommendation was determined. RESULTS: The task force members agreed on 7 overarching principles. The risk of reactivation of selected potentially latent infectious disease was addressed in migrants with inflammatory arthritis candidates for biologics was considered and 15 potentially relevant infections were identified. CONCLUSIONS: Fifteen disease-specific recommendations were formulated on the basis of high level of agreement among the experts panel.


Assuntos
Comitês Consultivos , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Doenças Transmissíveis/diagnóstico , Emigrantes e Imigrantes , Emigração e Imigração , Infectologia/normas , Programas de Rastreamento/normas , Reumatologia/normas , Sociedades Médicas , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/etnologia , Produtos Biológicos/efeitos adversos , Doenças Transmissíveis/etnologia , Consenso , Medicina Baseada em Evidências/normas , Humanos , Itália/epidemiologia , Programas de Rastreamento/métodos , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Espanha/epidemiologia
5.
Infection ; 45(4): 459-467, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28265870

RESUMO

PURPOSE: The spread of multidrug-resistant bacteria is a worrisome problem worldwide. This study investigated the correlation between antibiotic consumption and antimicrobial resistance trends of the most important bacteria causing bacteremia at the University hospital of Trieste, Italy, from 2008 to 2014. METHODS: Antibiotic consumption (Defined Daily Dose-DDD-per 100 patient/days) and antibiotic resistance (percentage of antibiotic intermediate o resistant isolates) were analyzed independently with linear correlation by year. Potential correlations between antibiotic consumption and bacteria resistance rates were investigated through the Pearson's correlation. RESULTS: The overall consumption of antibiotic grew from 80 to 97 DDD 100 patient/days (p = 0.005) during the study period. The increased consumption of amoxicillin/clavulanate and piperacillin/tazobactam was associated with the reduction of MRSA rate from 48.5 to 25.9% (p = 0.007 and p = 0.04, respectively). The increased consumption of piperacillin/tazobactam was associated with the reduction of ESBL-positive Enterobacteriaceae rate from 28.9 to 20.9% (p = 0.01). The increased consumption of carbapenems was associated with the increased rate of carbapenem-resistant Acinetobacter baumannii from 0 to 96.4% (p = 0.03). No carbapenem-resistant Enterobacteriaceae isolates were reported. The consumption of vancomycin grew significantly (p = 0.005). A dramatic spread of vancomycin-resistant Enterococcus faecium occurred in 2014. The consumption of fluoroquinolones and extended-spectrum cephalosporins remained stable. CONCLUSIONS: An antibiotic stewardship program targeted to limit the consumption of extended-spectrum cephalosporins and fluoroquinolones in favor of amoxicillin/clavulanate and piperacillin/tazobactam correlates with a decreasing rate of MRSA and ESBL-positive Enterobacteriaceae. The analysis of correlations between antibiotic consumption and bacterial resistance rates is a useful tool to orient antimicrobial stewardship policies at local level.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bactérias/efeitos dos fármacos , Farmacorresistência Bacteriana , Hospitais Universitários , Humanos , Itália
6.
Euro Surveill ; 21(31)2016 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-27525375

RESUMO

Strongyloides stercoralis is a soil-transmitted helminth widely diffused in tropical and subtropical regions of the world. Autochthonous cases have been also diagnosed sporadically in areas of temperate climate. We aimed at defining the epidemiology of strongyloidiasis in immigrants and Italians living in three northern Italian Regions. Screening for S. stercoralis infection was done with serology, confirmation tests were a second serological method or stool agar culture. A case-control approach was adopted and patients with a peripheral eosinophil count ≥ 500/mcL were classified as cases. Of 2,701 individuals enrolled here 1,351 were cases and 1,350 controls; 86% were Italians, 48% women. Italians testing positive were in 8% (97/1,137) cases and 1% (13/1,178) controls (adjusted odds ratio (aOR) 8.2; 95% confidence interval (CI): 4.5-14.8), while positive immigrants were in 17% (36/214) cases and in 2% (3/172) controls (aOR 9.6; 95% CI: 2.9-32.4). Factors associated with a higher risk of infection for all study participants were eosinophilia (p < 0.001) and immigration (p = 0.001). Overall, strongyloidiasis was nine-times more frequent in individuals with eosinophilia than in those with normal eosinophil count.


Assuntos
Anticorpos Anti-Helmínticos/sangue , Emigrantes e Imigrantes/estatística & dados numéricos , Fezes/parasitologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Animais , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Eosinofilia/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Regressão , Vigilância de Evento Sentinela , Distribuição por Sexo , Estrongiloidíase/sangue , Adulto Jovem
7.
Travel Med Infect Dis ; 12(6 Pt B): 713-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25131142

RESUMO

BACKGROUND: loiasis is a neglected filariasis, affecting millions of individuals living in the rainforest areas of West and Central Africa. Aim of this study was to compare clinical and parasitological manifestations of loiasis between subjects born in endemic areas and expatriates/travelers. METHODS: we report clinical and parasitological manifestations of 100 patients with imported loiasis seen between 1993 and 2013 at the Center of Tropical Diseases, Negrar, Italy. RESULTS: among the 100 patients, 30 were African immigrants, 70 were Europeans (59 long-term expatriates and 11 travelers). Thirty-five patients (19 Africans and 16 Europeans) had positive microfilaremia. Calabar swellings were twice as frequent in Europeans (90%) than in Africans (46.7%), while a history of "eyeworm" was recorded in a higher proportion of Africans (43.3%) than in Europeans (17.4%). The median duration of exposure in the non-endemic group was also fairly long (14.6 years). Different drug regimens were used for treatment. CONCLUSIONS: we suggest that the differences between Africans and Europeans are more likely to be related to genetic differences, rather than to chronicity. Moreover the management of imported loiasis needs standardization.


Assuntos
Loíase/epidemiologia , Dermatopatias Parasitárias/etnologia , Viagem , Adulto , Animais , População Negra , Emigrantes e Imigrantes , Feminino , Humanos , Itália , Loíase/tratamento farmacológico , Loíase/etnologia , Masculino , Dermatopatias Parasitárias/epidemiologia , População Branca
9.
Am J Trop Med Hyg ; 84(5): 733-7, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21540382

RESUMO

Loiasis, which is caused by the filarial nematode Loa loa, affects millions of persons living in the rainforest areas and savannah regions of central Africa. Typical manifestations are calabar swellings and the eyeworm. We report a case of loiasis with unusual clinical complications: a peripheral neuropathy and focal hypo-echogenic lesions of the spleen, which disappeared after treatment with albendazole and ivermectin. The literature reports that L. loa infection can be associated with various manifestations, some of them being serious. More information is needed to better characterize the protean manifestations of the disease in loiasis-endemic areas to evaluate the true incidence of loiasis.


Assuntos
Loíase/patologia , Sistema Nervoso Periférico/patologia , Baço/patologia , Adulto , Feminino , Humanos , Imageamento por Ressonância Magnética
10.
J Neurovirol ; 17(2): 196-9, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21445699

RESUMO

Progressive multifocal leukoencephalopathy (PML) has been traditionally associated to severe immunosuppression and described mainly in highly active antiretroviral therapy (HAART)-naïve patients with a low lymphocyte CD4+ count. In the last years, some cases of PML have been described in HIV patients with a higher CD4+ count shortly after initiation of HAART and in association with the immune reconstitution inflammatory syndrome (IRIS). We report on a rare case of PML, not IRIS associated, that occurred in a HIV-positive patient with a lymphocyte CD4+ count greater than 700/µl and with an undetectable HIV viral load resulting from a long-term HAART. We describe the pathological and the ultrastructural features of the brain lesion. This case confirms that a severe immunosuppression or an IRIS is not required for the development of PML in HIV positives. The diagnosis of PML should always be considered in patients with consistent neurological symptoms, even with a high lymphocyte CD4+ level and a full viral suppression resulting from a long-term HAART.


Assuntos
Síndrome da Imunodeficiência Adquirida/patologia , Antirretrovirais/administração & dosagem , Encéfalo/patologia , Encéfalo/virologia , Leucoencefalopatia Multifocal Progressiva/patologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/virologia , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Encéfalo/ultraestrutura , Contagem de Linfócito CD4 , DNA Viral/análise , Feminino , HIV/efeitos dos fármacos , HIV/crescimento & desenvolvimento , Humanos , Terapia de Imunossupressão , Itália , Vírus JC/patogenicidade , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Leucoencefalopatia Multifocal Progressiva/etiologia , Leucoencefalopatia Multifocal Progressiva/virologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Carga Viral
11.
J Travel Med ; 16(5): 317-21, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19796101

RESUMO

BACKGROUND: Seventy percent of imported malaria cases in Italy occur in immigrants, generally with milder clinical presentation due to premunition acquired through repeated infections. Nevertheless, premunition could be progressively lost after a long period of nonexposure. We investigated the changing pattern of malaria in immigrants in two definite 5-year periods one decade apart. METHODS: We retrospectively examined the main laboratory findings of all malaria cases observed in immigrants from 1990 to 1994 and from 2000 to 2004. We stratified patients by reason for traveling: subjects in Italy who traveled to visit friends and relatives (VFR) or new immigrants (NI). RESULTS: Forty-eight cases of malaria in immigrants occurred from 1990 to 1994, while 161 were observed from 2000 to 2004. Patients admitted in the latter period had a significantly higher parasitemia (median 6,298 vs 3,360 trophozoites/microL, p= 0.028) and lower platelet count (median 96.5 vs 132 x 10(9)/L, p= 0.012) and hemoglobin (median 12.6 vs 13.4 g/dL, p= 0.049). While NI did not show any significant difference in the two study periods, in the VFR subgroup a higher parasitemia (median 8,845 vs 2,690 trophozoites/microL, p= 0.003) and lower platelet count (median 96 vs 131 x 10(9)/L, p= 0.034) were observed during the second period, during which three cases of severe malaria occurred in VFR. A longer stay in Italy was reported in VFR admitted during the second study period (median 8.3 vs 5.7 years). CONCLUSIONS: We found a changing pattern of malaria presentation in immigrants over a decade. The most likely explanation is the longer average stay outside endemic countries and subsequent loss of premunition observed in the second cohort. Immigrants living in Italy for some time and traveling to VFR should no more be considered a low-risk group for severe malaria. Pretravel advice should be particularly targeted to this group.


Assuntos
Emigração e Imigração , Malária Falciparum/epidemiologia , Adulto , África Ocidental , Feminino , Humanos , Itália/epidemiologia , Malária Falciparum/sangue , Malária Falciparum/microbiologia , Masculino , Pessoa de Meia-Idade , Parasitemia/epidemiologia , Plasmodium falciparum/isolamento & purificação , Estudos Retrospectivos , Viagem , Adulto Jovem
12.
J Travel Med ; 15(4): 229-36, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-18666922

RESUMO

BACKGROUND: Since the year 2000, in Italy, there has been a constant decrease in the number of cases of imported malaria in immigrants. Nevertheless, immigrants still account for about 70% of reported cases. To our knowledge, no data are yet available on imported malaria in children. This paper describes the main characteristics of malaria cases observed in recent years in the three main hospitals in Verona (roughly representing 10% of all cases reported in Italy in the period), with a special focus on the poorly known problem of imported malaria in children. METHOD: All malaria cases occurring from 2000 to 2004 were retrospectively examined. Semi-immune and nonimmune patients were analyzed for clinical, laboratory, and parasitological findings. A separate analysis was carried out for children who traveled to endemic areas to visit relatives and friends (VRF) and children born in endemic countries who came to Italy for immigration purposes. RESULTS: A total of 380 cases of imported malaria occurred in Verona in the 5-year period, 43 being children. Semi-immune patients had a significantly lower parasitemia (p = 0.0032) and parasite clearance time and significantly shorter fever duration than nonimmune (p = 0.025 and p = 0.0026). VRF children presented significantly higher parasitemia and significantly lower platelet count (p = 0.016 and p = 0.042) than recent immigrants. Parasitemia clearance time and fever duration were longer in VRF children than in recent immigrants (p = 0.014 and p = 0.0085). We observed 23 cases of severe malaria, including 4 cases in immigrants. CONCLUSIONS: Our data confirm a significant difference both in clinical and in parasitological findings between semi-immune and nonimmune patients. We identified two populations of immigrant children: semi-immune (recent immigrants) and nonimmune (VRF). The latter is a high-risk group for severe malaria. Educational actions should be specially designed for immigrants traveling to VRF, focusing on the risk of severe malaria for both adults and children.


Assuntos
Transmissão de Doença Infecciosa/estatística & dados numéricos , Emigração e Imigração/estatística & dados numéricos , Malária/diagnóstico , Malária/epidemiologia , Adulto , Animais , Criança , Pré-Escolar , Controle de Doenças Transmissíveis/organização & administração , Feminino , Humanos , Lactente , Itália/epidemiologia , Malária/prevenção & controle , Malária Falciparum/diagnóstico , Malária Falciparum/epidemiologia , Malária Vivax/diagnóstico , Malária Vivax/epidemiologia , Masculino , Vigilância da População , Prevalência , Estudos Retrospectivos , Fatores de Risco , Viagem
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