Functional defect of natural immune system in an apparent immunocompetent patient with pulmonary cryptococcosis.

We report a case of pulmonary cryptococcosis in a 21-year-old Italian female smoker with no apparent immune disorder. In this study we demonstrated that: (i) patient's neutrophils and monocytes manifested a significant reduction of killing activity against Cryptococcus neoformans as well as Candida albicans; (ii) the suppression was more pronounced in monocytes than in neutrophils; (iii) neutrophils and monocytes showed a significant impairment of TNF-alpha, IL-1beta, and nitric oxide production. These results suggest that the apparent immunocompetent host with pulmonary cryptococcosis could have specific defects in natural immune system mechanisms.

[Nosocomial post-neurosurgery meningitis due to Corynebacterium jeikeium]. / Meningite nosocomiale post-neurochirurgica da Corynebacterium jeikeium.

Among the post neurosurgery infections the meningitis due to Corynebacterium jeikeium are rare, particularly without central nervous system devices. We report a case of a 78 year-old patient with chronic myeloproliferative syndrome, who developed an acute meningeal syndrome by Corynebacterium jeikeium post hypophyseal macroadenoma resection.

Acute transverse myelitis and hepatitis C virus.

In the last few years, substantial evidence has been provided on peripheral nervous involvement in infection by hepatitis C virus (HCV), whilst central nervous involvement is rare. Here, we report a case of acute transverse myelitis in a woman developing 4 years after documented HCV seropositivity, associated with intrathecal anti-HCV protein IgG. Isoelectrofocusing of all CSF samples before and after immunoabsorption with recombinant structural HCV proteins revealed disappearance or marked decrease of some oligoclonal IgG bands suggesting binding to HCV proteins. To our knowledge, this is the first report of acute myelitis associated with intrathecal immune response against HCV proteins. This finding suggests that in acute myelitis of unknown aetiology, testing CSF for HCV RNA and related antibodies is warranted.

Leishmaniasis in patients with chronic renal failure: a diagnostic and therapeutic challenge for the clinician.

BACKGROUND: The role of leishmaniasis in dialyzed or transplanted patients for chronic renal failure is generally neglected. In this study, the authors present a series of three cases of leishmaniasis (one visceral, one mucous and one muco-visceral) in patients with end-stage renal failure characterized by an atypical presentation and/or resistance to therapy. CASE DESCRIPTION: Two patients had an atypical infection: the first patient demonstrated a mucosal form, while the second had visceral and mucosal involvement. These two presentations are very rare and, to the best of our knowledge, other autoctonous disease cases have never been described in Italy. In the first patient, a cycle of oral itraconazole was scarcely effective and poorly tolerated, while treatment with 15% topical paromomycin sulfate was successful. Patients two and three failed to respond to meglumine antimonate and amphotericin B lipid complex. A second cycle with liposomal amphotericin B was effective in both cases. In addition, a superior safety profile for liposomal amphotericin B in comparison with the lipid complex amphotericin B was observed. CONCLUSIONS: These three cases highlight the problem of leishmaniasis in both renal transplanted and dialyzed patients and suggest that this infection could be far from infrequent in addition to being resistant to therapies. Leishmaniasis should be considered in the differential diagnosis of fevers of unknown origin and mucosal lesions in these patients, even in countries not at risk for mucosal leishmaniasis.

[Nosocomial infections in a general surgical ward]. / Le infezioni nosocomiali in un reparto di chirurgia generale.

According to the National Nosocomial Infection Surveillance system we analysed the post-surgical nosocomial infections in a surgery ward of Perugia University. Between May 2000 and April 2001, 677 patients were enrolled mean age 51.5 years: 355 (52%) male, 462 (68%) ASA score 1, "clean" surgery in 355 cases (52%), cephazolin prophylaxis in 256 (38%); 11 (2%) patients deceased perioperatively. A total of 37 nosocomial infections, in 33 patients, were detected: 18 pneumonia (48.6%), 10 surgical site infections (27%) with 18 isolated: 12 gram-negative (E. coli 3, Acinetobacter baumannii 2, Providencia stuartii 2, Pseudomonas aeruginosa 2, Achromobacter spp. 1, Citrobacter freundii 1, Morganella morgani 1) and 6 gram-positive (Staphylococcus aureus meticillin resistant 3, Enterococcus faecalis 2, Streptococcus salivarius 1); 7 sepsis (19%) due to 7 gram-positive (S. aureus meticillin resistant 4, S. aureus meticillin susceptible 1, Staphylococcus coagulase negative 1, Clostridium spp 1), 2 urinary tract infections (5.4%). Patients without infections and with nosocomial infections spent in hospital 6.3 and 16.6 days respectively. We can image that in one year 53 surgical procedure were lost, with a lost gain of 79.500-291.500 euro/year.

Nosocomial Aspergillus flavus wound infections following cardiac surgery.

In this report we describe three cases of Aspergillus flavus sternal wound infection following cardiac surgery. All three cases occurred in a 3-month period coinciding with hospital renovation activities. The patients were successfully treated with combined surgical and medical therapy.

[Nosocomial infections in vascular surgery: 1-year surveillance]. / Infezioni nosocomiali in chirurgia vascolare: un anno di sorveglianza.

Among the hospital related complications the nosocomial infections are a major source of problems, especially in the Intensive Care and in the Surgery Units. It has been clearly demonstrated that infection control programs, in Surgery Units, have a large benefit in the reduction of surgical site infections (SSIs) rates. The surveillance method, sponsored by the Centers for Diseases Control of Atlanta, is the most consolidated system and it is active since '70 years. We used this method in the Vascular Surgery Unit of Perugia Hospital. During a 12-month period, 668 consecutive patients were enrolled and followed, after surgery, for 30 days (without implantable devices) or 1 year (with prosthesis). A total of 14 (2.1%) patients had SSIs: 4 superficial, 4 deep, 6 organ-space. We isolated 13 pathogens: 8 gram-positive, 4 gram-negative, and one Candida albicians. The most prevalent pathogen isolated was Staphylococcus aureus methicillin-susceptible. This first positive experience will be used for further more generalized work involving the principal surgical Unit of the Umbria Region.

Outbreak of infusion-related septicemia by Ralstonia pickettii in the Oncology Department.

Hospital acquired blood stream infection by Ralstonia pickettii in 9 cancer patients related to the heparin solution contamination used to flush the central venous catheter.

Primary brain abscess with Nocardia farcinica in an immunocompetent patient.

In this paper, we describe a case of an immunocompetent patient with cerebral nocardiosis. The onset was with loss of strength, paresthesia and focal epilepsy of the left arm. MRI showed on T2-weighted sequences a hyperintense central area of pus surrounded by a well-defined hypointense capsule and surrounding edema; on T1-weighted sequences a hypointense necrotic cavity with ring enhancement following administration of intravenous gadolinium. The patient underwent surgical excision of the abscess but culture from the specimen was negative. After 40 days of empirical antimicrobial therapy he developed neurological deterioration with focal epilepsy. A new MRI documented an enlargement of the hypointense lesion in the right frontal-parietal region. A second craniotomy with drainage of the abscess was performed; cultures yielded Nocardia farcinica. Therapy with trimethoprim/sulfamethoxazole, amikacin and meropenem was given for 35 days, and clinical and radiological improvement was observed. Home therapy was done with oral trimethoprim/sulfamethoxazole. Currently, 5 months from the second surgery, the patient can walk with support and no new episodes of epilepsy occurred. Side effects were absent from therapy. The MRI appearance of the brain lesion has improved, with a decrease in size, surrounding edema and ring enhancement.