RESUMEN
Acute respiratory tract infections (ARI) are common diseases in children and adults and could cause severe infections in high-risk patients, like the immunocompromised and elderly, and are the leading cause of morbidity, hospitalization and mortality. This study aimed to explore the prevalence of respiratory viruses and the clinical impact of single- and multi-infection among hospitalized patients in various age groups. 3578 nasopharyngeal swabs (NPS) were analyzed for pathogen detection of acute respiratory tract infections. 930 out of 3578 NPS were diagnosed positive for at least one respiratory virus. The distribution of viral infections, prevalence and pathogen, differed significantly among age groups. Most RTI are observed in the age group over 65 years (50.6%) with a high SARS-CoV2 prevalence, following by group <5 years (25.6%), where the most frequently detected viruses were RSV, Rhinovirus, FluA-H3, MPV, and AdV. The co-infection rate also varies according to age and, in some cases, especially in older adults, could have severe clinical impact. This study emphasizes that it is important to know and analyze, in all age groups of hospitalized patients, the epidemiology of respiratory viruses, the prevalence of coinfections, and the clinical impact of various pathogens. Furthermore, in a clinical setting, the rapid diagnosis of respiratory infections by means of molecular tests is crucial not only to avoid hospital outbreaks, but also to allow early and optimal treatment to reduce morbidity and mortality.
Asunto(s)
Coinfección , Infecciones del Sistema Respiratorio , Humanos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/virología , Anciano , Adulto , Persona de Mediana Edad , Preescolar , Adolescente , Niño , Masculino , Adulto Joven , Femenino , Lactante , Coinfección/epidemiología , Coinfección/virología , Anciano de 80 o más Años , COVID-19/epidemiología , Prevalencia , Hospitalización , SARS-CoV-2 , Virosis/epidemiología , Virosis/virología , Recién Nacido , Pandemias , Virus/aislamiento & purificación , Virus/clasificación , Virus/genéticaRESUMEN
Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome (PTS), is a distinct idiopathic immune-mediated neuritis of the brachial plexus, characterized by sudden attacks of severe neuropathic pain usually in the shoulder and/or arm, followed by progressive neurologic deficits, including weakness, atrophy, and occasionally sensory abnormalities. Pathogenesis is assumed to be multifactorial, and several observations support the hypothesis of an immune-triggering event preceding PTS, most frequently infections. A literature review reveals a variety of clinical presentations and courses. Various microorganisms preceding PTS have been documented. The authors report a case of PTS related to cytomegalovirus infection with a review of the relevant literature. Special emphasis is placed on the most important infectious agents considered in the etiological list of PTS.
Asunto(s)
Neuritis del Plexo Braquial , Infecciones por Citomegalovirus , Neuritis del Plexo Braquial/diagnóstico , Neuritis del Plexo Braquial/etiología , Neuritis del Plexo Braquial/patología , Citomegalovirus , Infecciones por Citomegalovirus/complicaciones , Humanos , Hombro/patologíaRESUMEN
From April to October 2017, 27 cases of Hepatitis A (HA), 22 male and 5 female, were reported in Cosenza (South Italy). The median age of cases was 32 years (range 3-49 years). Out of 21 male adults, 14 were identified as men who have sex with men (MSM). Phylogenetic analysis was conducted in 15 cases and revealed two distinct sequences of genotype IA linking to clusters recognised in MSM in other European countries in 2016; genotype IB was recognized in only 2 cases. The report confirms that HA is an emerging issue among MSM. As suggested by the WHO, in countries with low HAV circulation, vaccination programmes should be tailored on local epidemiological patterns to prevent outbreaks among high risk groups and eventual spill-over of the infection into the general population.
Asunto(s)
Brotes de Enfermedades , Hepatitis A , Minorías Sexuales y de Género , Adolescente , Adulto , Niño , Preescolar , Femenino , Genotipo , Hepatitis A/epidemiología , Hepatitis A/virología , Virus de la Hepatitis A Humana/clasificación , Virus de la Hepatitis A Humana/genética , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Tipificación Molecular , Filogenia , Adulto JovenRESUMEN
Keywords: carbazole; tetrahydrocarbazole; antiviral agents.
Asunto(s)
Antivirales/farmacología , Carbazoles/farmacología , Virosis/epidemiología , Animales , Antivirales/química , Antivirales/uso terapéutico , Carbazoles/química , Carbazoles/uso terapéutico , Humanos , Estructura Molecular , Mutación , Pandemias/veterinaria , Virosis/tratamiento farmacológico , Virus/efectos de los fármacos , Virus/genéticaRESUMEN
Background and objectives: To enter the target cell, HIV-1 binds not only CD4 but also a co-receptor ß-chemokine receptor 5 (CCR5) or α chemokine receptor 4 (CXCR4). Limited information is available on the impact of co-receptor usage on HIV-1 replication in monocyte-derived macrophages (MDM) and on the homeostasis of this important cellular reservoir. Materials and Methods: Replication (measured by p24 production) of the CCR5-tropic 81A strain increased up to 10 days post-infection and then reached a plateau. Conversely, the replication of the CXCR4-tropic NL4.3 strain (after an initial increase up to day 7) underwent a drastic decrease becoming almost undetectable after 10 days post-infection. The ability of CCR5-tropic and CXCR4-tropic strains to induce cell death in MDM was then evaluated. While for CCR5-tropic 81A the rate of apoptosis in MDM was comparable to uninfected MDM, the infection of CXCR4-tropic NL4.3 in MDM was associated with a rate of 14.3% of apoptotic cells at day 6 reaching a peak of 43.5% at day 10 post-infection. Results: This suggests that the decrease in CXCR4-tropic strain replication in MDM can be due to their ability to induce cell death in MDM. The increase in apoptosis was paralleled with a 2-fold increase in the phosphorylated form of p38 compared to WT. Furthermore, microarray analysis showed modulation of proapoptotic and cancer-related genes induced by CXCR4-tropic strains starting from 24 h after infection, whereas CCR5 viruses modulated the expression of genes not correlated with apoptotic-pathways. Conclusions: In conclusion, CXCR4-tropic strains can induce a remarkable depletion of MDM. Conversely, MDM can represent an important cellular reservoir for CCR5-tropic strains supporting the role of CCR5-usage in HIV-1 pathogenesis and as a pharmacological target to contribute to an HIV-1 cure.
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VIH-1/efectos de los fármacos , VIH-1/crecimiento & desarrollo , Compuestos Heterocíclicos/farmacología , Macrófagos/efectos de los fármacos , Fármacos Anti-VIH/farmacología , Bencilaminas , Ciclamas , Fragmentación del ADN/efectos de los fármacos , VIH-1/aislamiento & purificación , Humanos , Receptores CCR5/efectos de los fármacos , Receptores CCR5/genética , Receptores CXCR4/efectos de los fármacos , Receptores CXCR4/genéticaRESUMEN
Different fluoroquinolon-type antibiotics were conjugated to gelatin with the aim to synthesize biomacromolecules with antimicrobial properties. The covalent linkage of the antibiotic was performed by a radical process involving the residues in the side chains of gelatin able to undergo oxidative modifications. The conjugation of antibiotic moieties onto the protein structure was confirmed by FT-IR, UV-Vis, fluorescence, and calorimetric analyses. Biocompatibility tests were performed on human bone marrow mesenchymal stromal cells and the antibacterial properties of bioactive polymers were investigated by appropriate tests against Klebsiella pneumoniae and Escherichia coli. With regard to the tests conducted in the presence of E. coli, a minimum inhibitory concentration (MIC) ranging from 0.05 to 0.40 µg mL(-1) was recorded, while in the presence of K. pneumoniae this concentration varies from 0.10 to 1.60 µg mL(-1). In all the conjugates, the drug moieties retain their biological activity and the MIC values are lower than the resistance parameters of fluoroquinolon-type antibiotics versus Enterobacteriacae. The collected data suggest a broad range of applications, from biomedical to pharmaceutical and food science for all conjugates.
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Antibacterianos/síntesis química , Antibacterianos/farmacología , Fluoroquinolonas/síntesis química , Fluoroquinolonas/farmacología , Antibacterianos/química , Materiales Biocompatibles/síntesis química , Materiales Biocompatibles/química , Materiales Biocompatibles/farmacología , Células Cultivadas , Escherichia coli/efectos de los fármacos , Fluoroquinolonas/química , Gelatina/química , Células Madre Hematopoyéticas/efectos de los fármacos , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Ensayo de Materiales , Pruebas de Sensibilidad Microbiana , Estructura MolecularRESUMEN
A unique case of severe measles complicated by multiple features of gas accumulation is described, on the ground of the available literature evidences. Complications from measles have been reported in every organ system and they may vary by age and underlying conditions. Pneumomediastinum is usually associated with subcutaneous emphysema and pneumopericardium, but rarely associated with pneumothorax. We report extremely rare simultaneous occurrence of self-limiting pneumomediastinum, pneumopericardium, subcutaneous neck and chest region emphysema, and pneumothorax, in a 19-year-old girl with measles. A review of the literature has documented only one previous report of spontaneous pneumomediastinum, subcutaneous emphysema and pneumothorax in the course of measles, and no previous cases reported the association of pneumomediastinum, subcutaneous emphysema, pneumopericardium and pneumothorax complicating measles.
Asunto(s)
Enfisema Mediastínico , Neumopericardio , Neumotórax , Enfisema Subcutáneo , Femenino , Humanos , Adulto Joven , Adulto , Neumotórax/etiología , Neumotórax/complicaciones , Enfisema Mediastínico/etiología , Enfisema Mediastínico/complicaciones , Neumopericardio/etiología , Neumopericardio/complicaciones , Tomografía Computarizada por Rayos X , Enfisema Subcutáneo/etiología , Enfisema Subcutáneo/complicacionesRESUMEN
BACKGROUND: Infection with high-risk human papillomavirus (HR-HPV) genotypes, mainly HPV16 and HPV18, is a major risk factor for cervical cancer and responsible for its progression. While the transforming role of the HPV E6 and E7 proteins is more characterized, the molecular mechanisms of the oncogenic activity of the E5 product are still only partially understood, but appear to involve deregulation of growth factor receptor expression. Since the signaling of the transforming growth factor beta (TGFbeta) is known to play crucial roles in the epithelial carcinogenesis, aim of this study was to investigate if HPV16 E5 would modulate the TGF-BRII expression and TGFbeta/Smad signaling. FINDINGS: The HPV16 E5 mRNA expression pattern was variable in low-grade squamous intraepithelial lesions (LSIL), while homogeneously reduced in high-grade lesions (HSIL). Parallel analysis of TGFBRII mRNA showed that the receptor transcript levels were also variable in LSILs and inversely related to those of the viral protein. In vitro quantitation of the TGFBRII mRNA and protein in human keratinocytes expressing 16E5 in a dose-dependent and time-dependent manner showed a progressive down-modulation of the receptor. Phosphorylation of Smad2 and nuclear translocation of Smad4 were also decreased in E5-expressing cells stimulated with TGFbeta1. CONCLUSIONS: Taken together our results indicate that HPV16 E5 expression is able to attenuate the TGFbeta1/Smad signaling and propose that this loss of signal transduction, leading to destabilization of the epithelial homeostasis at very early stages of viral infection, may represent a crucial mechanism of promotion of the HPV-mediated cervical carcinogenesis.
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Expresión Génica , Proteínas Oncogénicas Virales/genética , Transducción de Señal , Factor de Crecimiento Transformador beta/metabolismo , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Clasificación del Tumor , Proteínas Oncogénicas Virales/metabolismo , ARN Mensajero/genética , Proteínas Smad/metabolismo , Factores de Tiempo , Factor de Crecimiento Transformador beta/genética , Displasia del Cuello del Útero/genética , Displasia del Cuello del Útero/metabolismo , Displasia del Cuello del Útero/patologíaRESUMEN
Two recent cases of extremely severe thrombocytopenic purpura related to a concomitant cytomegalovirus infection, either associated or not with an underlying immunosuppression, draw our attention on this intriguing pathologic association, on the ground of an updated literature review.
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Infecciones por Citomegalovirus , Trombocitopenia , Humanos , Infecciones por Citomegalovirus/complicaciones , Huésped Inmunocomprometido , Trombocitopenia/etiologíaRESUMEN
Both the safety and effectiveness of intrathecal tigecycline (TGC) for treatment of infections of the central nervous system (CNS) are discussed using the clinical findings from a study of a recent patient who came to our attention, along with a literature review. Although penetration into the CNS is low (approximately 11%), intraventricular TGC could help treat patients with severe post- neurosurgical CNS infections. The use of multiple routes of TGC administration appears to be encouraging and should be considered in managing life-threatening intraventricular infections.
RESUMEN
A unique report of Schönlein-Henoch purpura (SHP) associated with a recent Giardia lamblia enteric infection is described and discussed on the ground of the available literature. Tinidazole plus an appropriate probiotic therapy, including Lactobacillus reuteri and vitamin D, proved to be effective in the condition. SHP is an immunocomplex-mediated disorder characterised by a number of differently associated signs and symptoms, leading to the possible involvement of the skin, joints, abdomen and kidneys. Recent bacterial, viral, or protozoan infections may trigger the disease onset in patients of all ages. The paper describes the first case of SHP triggered by a giardiasis. Tinidazole plus an appropriate probiotic therapy, i.e. L. reuteri and vitamin D proved to be effective in this condition. To our knowledge, this is the first reported case of lambliasis-associated SHP described in an international traveller.
Asunto(s)
Giardiasis , Vasculitis por IgA , Humanos , Vasculitis por IgA/complicaciones , Vasculitis por IgA/diagnóstico , Giardiasis/complicaciones , Tinidazol , Vitamina D , ItaliaRESUMEN
AIMS: To assess influenza viruses (IVs) circulation and to evaluate A(H3N2) molecular evolution during the 2021-2022 season in Italy. MATERIALS AND METHODS: 12,393 respiratory specimens (nasopharyngeal swabs or broncho-alveolar lavages) collected from in/outpatients with influenza illness in the period spanning from January 1, 2022 (week 2022-01) to May 31, 2022 (week 2022-22) were analysed to identify IV genome and were molecularly characterized by 12 laboratories throughout Italy. A(H3N2) evolution was studied by conducting an in-depth phylogenetic analysis of the hemagglutinin (HA) gene sequences. The predicted vaccine efficacy (pVE) of vaccine strain against circulating A(H3N2) viruses was estimated using the sequence-based Pepitope model. RESULTS: The overall IV-positive rate was 7.2% (894/12,393), all were type A IVs. Almost all influenza A viruses (846/894; 94.6%) were H3N2 that circulated in Italy with a clear epidemic trend, with 10% positivity rate threshold crossed for six consecutive weeks from week 2022-11 to week 2022-16. According to the phylogenetic analysis of a subset of A(H3N2) strains (n=161), the study HA sequences were distributed into five different genetic clusters, all of them belonging to the clade 3C.2a, sub-clade 3C.2a1 and the genetic subgroup 3C.2a1b.2a.2. The selective pressure analysis of A(H3N2) sequences showed evidence of diversifying selection particularly in the amino acid position 156. The comparison between the predicted amino acid sequence of the 2021-2022 vaccine strain (A/Cambodia/e0826360/2020) and the study strains revealed 65 mutations in 59 HA amino acid positions, including the substitution H156S and Y159N in antigenic site B, within major antigenic sites adjacent to the receptor-binding site, suggesting the presence of drifted strains. According to the sequence-based Pepitope model, antigenic site B was the dominant antigenic site and the p(VE) against circulating A(H3N2) viruses was estimated to be -28.9%. DISCUSSION AND CONCLUSION: After a long period of very low IV activity since public health control measures have been introduced to face COVID-19 pandemic, along came A(H3N2) with a new phylogenetic makeup. Although the delayed 2021-2022 influenza season in Italy was characterized by a significant reduction of the width of the epidemic curve and in the intensity of the influenza activity compared to historical data, a marked genetic diversity of the HA of circulating A(H3N2) strains was observed. The identification of the H156S and Y159N substitutions within the main antigenic sites of most HA sequences also suggested the circulation of drifted variants with respect to the 2021-2022 vaccine strain. Molecular surveillance plays a critical role in the influenza surveillance architecture and it has to be strengthened also at local level to timely assess vaccine effectiveness and detect novel strains with potential impact on public health.
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COVID-19 , Vacunas contra la Influenza , Gripe Humana , Humanos , Hemaglutininas , Subtipo H3N2 del Virus de la Influenza A/genética , Filogenia , Glicoproteínas Hemaglutininas del Virus de la Influenza/genética , Pandemias , Estaciones del Año , COVID-19/epidemiología , Epítopos , Italia/epidemiologíaRESUMEN
This brief report documents the safety and efficacy of high-dose tigecycline as a salvage-therapy in in a case series of five patients with serious central nervous system (CNS) rocky mountain spotted fever (RMSF). These severily ill patients were unable to take any oral drug therapy, parenteral doxycycline was unavailable and absorption of oral doxycycline was a concern in these critically ill patients. As far as we know, we report the successfull use of tigecycline for the treatment of rickettsial meningitis for the first time in Italy. We suggest more studies on tigecycline in severe CNS infections from Rickettsia species and multi-drug resistant bacteria, especially the use of tigecycline at higher than standard doses in these life-threathening infectious diseases.
RESUMEN
Glecaprevir (GLE)/pibrentasvir (PIB) is a pangenotypic direct-acting antiviral regimen approved for treating chronic hepatitis C virus. Primary treatment and re-treatment with GLE/PIB are effective and safe for patients without decompensated liver cirrhosis and chronic hepatitis C in a real-world clinical setting. However, in the context of compensated cirrhosis and concomitant administration of inhibitors of cytochromes, a careful monitoring of liver biomarkers, as well as therapeutic drug monitoring (TDM), may be advisable during GLE/PIB therapy. The GLE / PIB combination is very effective and safe in achieving a sustained virological response, but it can be associated with the development of severe hepatic adverse events, which require virological and serum concentration monitoring of the two drugs to prevent a serious liver damage. The possible onset of hyperbilirubinemia must not necessarily lead to the suspension of therapy, because the phenomenon may be transient. We report what is likely the first known case of severe jaundice after treatment with GLE/PIB in Italy in a patient with compensated chronic hepatitis in the context of HIV disease.
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Infecciones por VIH , Hepatitis C Crónica , Ictericia , Humanos , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Antivirales/efectos adversos , Hiperbilirrubinemia/inducido químicamente , Hiperbilirrubinemia/tratamiento farmacológico , Ictericia/inducido químicamente , Ictericia/tratamiento farmacológico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológicoRESUMEN
Oseltamivir is an orally administered antiviral medication that selectively inhibits the influenza neuraminidase enzymes that are essential for viral replication and it is active against both influenza A and B viruses. Oseltamivir is indicated for therapy or post-exposure prevention of influenza A and B. Side effects are uncommon and include mild nausea, gastrointestinal upset, dizziness, and headache. Despite widespread use, oseltamivir has not been associated with clinically apparent liver injury; however, there is growing evidence of possible toxic liver involvement during oseltamivir therapy. To the best of our knowledge, this is the first reported case in Italy linking the development of acute hepatitis and oseltamivir therapy, in a patient suffering from influenza H1N1 infection. We also present a review of the literature on cases of oseltamivir hepatotoxicity, through the consultation of PubMed database, the bibliographical references of various articles and an extensive search using Google. In view of the analyzed results, we suggest that experts should carefully consider the need for inclusion of potential serious liver reactions be added to the oseltamivir product label.
Asunto(s)
Hepatitis , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana , Enfermedad Aguda , Antivirales/efectos adversos , Hepatitis/tratamiento farmacológico , Humanos , Gripe Humana/tratamiento farmacológico , Oseltamivir/efectos adversosRESUMEN
This retrospective multicenter cohort study investigated the kinetics (ascending and descending phases) of cytomegalovirus (CMV) and Epstein-Barr virus (EBV)-DNA in whole blood (WB) and plasma samples collected from adult kidney transplant (KT) recipients. CMV-DNA kinetics according to antiviral therapy were investigated. Three hundred twenty-eight paired samples from 42 episodes of CMV infection and 157 paired samples from 26 episodes of EBV infection were analyzed by a single commercial molecular method approved by regulatory agencies for both matrices. CMV-DNAemia followed different kinetics in WB and plasma. In the descending phase of infection, a slower decay of viral load and a higher percentage of CMV-DNA positive samples were observed in plasma versus WB. In the 72.4% of patients receiving antiviral therapy, monitoring with plasma CMV-DNAemia versus WB CMV-DNAemia could delay treatment interruption by 7-14 days. Discontinuation of therapy based on WB monitoring did not result in relapsed infection in any patients. Highly different EBV-DNA kinetics in WB and plasma were observed due to lower positivity in plasma; EBV positive samples with a quantitative result in both blood compartments were observed in only 11.5% of cases. Our results emphasize the potential role of WB as specimen type for post-KT surveillance of both infections for disease prevention and management.
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Citomegalovirus/genética , ADN Viral/sangre , Herpesvirus Humano 4/genética , Trasplante de Riñón , Adulto , Antivirales/farmacología , Estudios de Cohortes , Citomegalovirus/efectos de los fármacos , Citomegalovirus/fisiología , Herpesvirus Humano 4/efectos de los fármacos , Herpesvirus Humano 4/fisiología , Humanos , Inmunosupresores/farmacología , Cinética , Estudios RetrospectivosAsunto(s)
Infecciones por Bunyaviridae/diagnóstico , Meningitis Viral/diagnóstico , Virus de Nápoles de la Fiebre de la Mosca de los Arenales/aislamiento & purificación , Adulto , Infecciones por Bunyaviridae/virología , Humanos , Masculino , Meningitis Viral/virología , Virus de Nápoles de la Fiebre de la Mosca de los Arenales/genéticaRESUMEN
BACKGROUND: Although analysis of the Human papillomavirus (HPV) genotype spread in a particular area has a crucial impact on public health and prevention programmes, there is a lack of epidemiological data regarding HPV in the Calabria region of Italy. We therefore update information on HPV age/genotype distribution by retrospectively analysing a cohort of women, with and without cervical lesions, living in Calabria, who underwent HPV DNA testing; moreover, we also evaluated HPV age/genotype distribution in a subset of patients with cervical lesions. METHODS: Cervical scrape specimens obtained from 9590 women (age range 20-75 years) from January 2010 to December 2015 were tested for HPV DNA. Viral types were genotyped by Linear Array HPV Genotyping® test (Roche, USA) at the Clinical Microbiology Operative Unit of six hospitals located in four provinces of the Calabria region. Cervical scrape specimens were also used to perform Pap smears for cytological analysis in a subset of 405 women; cytological classification of the samples was performed according to the Bethesda classification system. RESULTS: A total of 2974 women (31%) (C.I. 95% 30.09-31.94) were found to be HPV DNA positive for at least one (57.3%) or several (42.7%) HPV genotypes. Of single genotype HPV infections, 46.5% and 36.4 % were classed as high-risk (HR, Group 1) and low-risk (LR, Group 3) respectively, while 16.9% were classed as probably/possibly carcinogenic and 0.2% undetermined risk. Stratified by age, total HPV distribution, showed the highest prevalence within the range 30-39 years (37.2%), while single genotype infection distribution displayed a peak in women from the age range 20-29 years (37.5%). The most common high-risk HPV type was HPV 16 (19.1%), followed by HPV 31 (9.1%). CONCLUSIONS: We provide epidemiological data on HPV age/genotype distribution in women living in the Calabria region with or without cytological abnormalities, further to the enhancement of HPV screening/prevention programmes for the local population.