Changing epidemiology of hepatitis C in Italy: a population-based survey in a historically high endemic area.

BACKGROUND: General population data on hepatitis C virus (HCV) prevalence in Italy come mostly from studies conducted in small towns. The highest rates have consistently been found in southern regions, especially in Calabria. Herein, we aimed to determine HCV prevalence, awareness, and risk factors in the general population of Catanzaro, the capital city of Calabria, Italy. METHODS: A stratified probability-based random sample of adult population was drawn from the Census. Anti-HCV and HCV-RNA were assayed. Data on sociodemographycs, risk factors and awareness of infection status were also collected. Crude and age and sex directly standardized rates (DSR), using Catanzaro's general population as standard, were calculated. Log binomial regressions with sampling weights was used to identify independent predictors of infection. RESULTS: The final study population consisted of 1003 people. Of them 27 (2.69%; 95% confidence interval, [CI] 1.78-3.89) (DSR: 2.34%; 95% CI: 1.37-3.30) and 9 (0.9%; 95% CI: 0.41-1.70) (DSR: 0.79%; 95% CI: 0.21-1.37) were anti-HCV and HCV RNA positive, respectively. Most HCV-positive participants were older people. Age ≥65 and past use of illicit drugs were both positive independent predictors of anti-HCV positivity, while female sex was an independent protective predictor of infection. Only 9 (33.3%) of anti-HCV positive participants had awareness of their status. CONCLUSIONS: We detected a much lower anti-HCV prevalence than those previously found in Calabria, along with a substantial change in HCV transmission modes. Infected people were almost only elderly and mostly unaware of their infection. Improving diagnosis and linkage to care for these infected persons would be needed.

Role of IgG and IgM and proinflammatory non-specific markers in the diagnosis and prognosis of COVID-19 patients stratified by number of positive SARS-CoV-2 genes.

BACKGROUND: A prompt set of suitable biomarkers is needed in suspected COVID-19 patients. This study aims to assess patients positive for one or more gene associated with the C reactive protein (CRP) and procalcitonin (PCT) as non-specific pro-inflammatory markers and IgG and IgM kinetic as specific diagnostic and prognostic tools in SARS-CoV-2 RT-PCR positive patients. METHODS: We enrolled 101 patients within a two month time span (March 26th, 2020 to May 31st, 2020). A reverse transcription-Real-Time PCR assay on nasopharyngeal/oropharyngeal swabs was used for SARS-CoV-2 identification. Serum anti-SARS-CoV-2 IgM and IgG were measured by enzyme immunoassay, PCT levels by Enzyme linked fluorescent assay (ELFA)and CRP by nephelometry. RESULTS: We found that older patients were significantly associated with a worse prognosis. Serum IgM levels were significantly lower during the late stage of the disease, regardless of the presence of one or three genes and patients' outcome. On the contrary, IgG levels exhibited a higher concentration in the late phases of the illness, regardless of the gene found or patients' prognosis. With the exception of the very first sample tested, an increase in CRP in surviving patients (both one and three genes) and a time-dependent decrease of deceased patients CRP was found. PCT levels were always within the normal reference range. The difference between one gene and three genes patients was significant during late disease stages regarding IgG levels and also between three genes survivors versus three genes deceased, where the IgG levels were progressively increasing over time. CONCLUSIONS: The relevant finding of the present study is the significant and consistent increase of IgG and IgM in deceased patients. The associated evaluation of antibody kinetics and non specific inflammatory markers (CRP and PCT) in positive patients stratified according to the presence of one gene or three genes could help the clinician in both the diagnosis and prognosis of COVID-19 patients.

Utility of Molecular Identification and Quantitation of Bartonella Species with Species-Specific Real-Time PCR for Monitoring Treatment Response: A Case Series.

BACKGROUND: Bartonella species are intracellular bacteria capable of producing several diseases in humans. The three most common and wellknown diseases are cat scratch disease (CSD), caused by B. henselae, trench fever, caused by B. quintana and Carrion's Disease, caused by B. bacilliformis. Signs and symptoms are very different and aspecific: Fatigue, fever, headache, lymphadenopathy, malaise, loss of weight. No data exist to support guidelines' recommendations to decide which drugs should be optimally used and how long they should be administered. Therefore, a marker of treatment response is needed to guide treatment strategies. METHODS: We report herein three cases in which a species specific Reverse-Transcriptase Polymerase-Chain-Reaction (RT PCR) developed in-house was performed and compared to serology in order to make diagnosis and to evaluate treatment response. RESULTS: Our species-specific RT PCR seemed to play a fundamental role both in diagnosis and treatment. Moreover, a discrepancy with the serology results was found. CONCLUSION: Further studies are necessary to validate these results and elucidate what is the best treatment for this pleomorphic disease. However, in absence of clear guidelines, RT PCR may be useful to orientate kind of treatment ad its duration.

Soluble CD14 Subtype-A New Biomarker in Predicting the Outcome of Critically Ill Septic Patients.

BACKGROUND: We evaluated the role of presepsin (soluble CD14 subtype, sCD14-ST) in predicting the outcome of critically ill septic patients in parallel with procalcitonin and C-reactive protein. METHODS: This study was an observational, prospective study that enrolled 58 surgical and medical intensive care unit patients with suspected sepsis. All studied subjects were retrospectively stratified into survivors and nonsurvivors based on 28 days survival and according to microbiological results in blood culture positive and negative groups. Plasma and serum samples from each patient were collected at admission (T-0), after 24-48 hours (T-1) and after 7 days (T-2). Statistics were obtained using Student׳s t test and ANOVA, as well as Bonferroni post hoc test. Receiver-operating characteristic (ROC) analysis was also performed. RESULTS: Presepsin levels were significantly higher at T-0 (P = 0.0007), at T-1 (P < 0.0001) and at T-2 (P < 0.0001) in nonsurvivors versus survivors at the same time point. Presepsin concentrations were significantly increased at T-0 (P = 0.0073), T1 (P = 0.0111) and T2 (P = 0.0167) in patients with positive blood cultures in comparison to patients with negative cultures at the same time. For all time periods evaluated, presepsin data from nonsurviving and surviving individuals were subjected to ROC analysis that demonstrated an excellent accuracy and significant area under the ROC curve (P < 0.0001). Results of multivariate analysis indicated presepsin as a predictive independent variable among prognosis markers at T-0 (P = 0.016). CONCLUSIONS: Presepsin revealed an optimal prognostic performance in patients with severe sepsis and provided interesting diagnostic value. Prediction of outcome in critically ill patients is crucial to optimize management decisions and level of treatment.