Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000.

A one-day survey was carried out in 88 out of 113 public hospitals in Lombardy to obtain prevalence rates of hospital-acquired infections (HAIs) by hospital departments and to identify the pathogens more frequently involved. In total 18667 patients were surveyed, representing 72% of the average daily total of occupied beds in public hospitals in Lombardy. The overall prevalence of HAI was 4.9%. The highest prevalence was observed in intensive care units and in spinal units. The prevalence of bloodstream infections was 0.6%; pneumonia 1.1%; urinary tract infections 1.6% and gastrointestinal infections 0.4%. In surgical patients the prevalence of surgical site infections was 2.7%. The most frequently isolated pathogen from all sites of infections was Escherichia coli (16.8%), followed by Staphylococcus aureus (15.0%), Pseudomonas aeruginosa (13.2%) and Candida spp. (8.7%). Methicillin-resistant S. aureus accounted for 23% of all isolated S. aureus. The results provide baseline data for rational priorities in allocation of resources, for further studies and for infection control activities.

Retrobulbar optic neuritis in a patient with acute type B hepatitis.

A case is described of retrobulbar optic neuritis in a 33-year-old female with acute type B hepatitis. The ocular distress, principally affecting the left eye, followed the normalisation of liver function tests and subsided after steroid therapy. At the onset of ocular symptomatology, complement activation, involving both classic and alternative pathways, and high levels of circulating immune complexes were present. HBsAg was positive. No relapse was observed during follow-up for 3 years. An association between HBV-infection, optic neuritis and an immune complexes-mediated neurotoxic activity are hypothetized.

Sporadic acute non-A non-B hepatitis complicated by aplastic anemia.

A 19-year-old woman developed acute jaundice and abnormal liver tests showing acute viral hepatitis, presumably non-A non-B. The viral hepatitis, on the 4th day after admission, was complicated by aplastic anemia. Therapy with hydrocortisone promptly instituted was ineffective and a bone marrow transplantation was not possible because we could not find a compatible donor. Sixty-five days after admission the patient died of infection by Candida tropicalis. Postmortem examination showed total medullary aplasia with massive impoverishment of all the lymphatic structures and multiple fungal infarctions in the myocardium, lungs, spleen, kidneys, and liver.

Mixed Schistosoma infection in an asymptomatic patient.

We report a case of a male, 26 years old Egyptian patient, who was investigated for a long-lasting hepatomegaly and altered transaminase levels. No symptom was reported. Liver biopsy and intestinal biopsy were positive for S. mansoni ova. Urine test initially showed negativity for S. haematobium ova, which only appeared with subsequent investigation, in spite of lack of urinary symptomatology.

Cryoglobulinaemia in a patient with Proteus mirabilis sepsis.

Mixed polyclonal cryoglobulinaemia was evidenced in a 49-year-old woman admitted to our hospital because of Proteus mirabilis sepsis associated with polyarthralgia and purpuric manifestations on the lower limbs. Cryoglobulins and circulating immune complexes decreased during the second week of illness and disappeared after recovery. CH50, C3 and properdin factor B, which were low during the early phase of the illness, returned to normal; C4 was normal throughout. The rapid clearance of cryoglobulins and immune complexes and the restoration of a normal complement profile might all be explained by the gradual elimination of P. mirabilis due to chemotherapeutic treatment.