The effect of fresh human serum on ofloxacin bactericidal activity.

We have studied the possibility of an increase in ofloxacin bactericidal activity when it is combined with fresh human serum. The tested strains were 10 clinical isolates of Klebsiella pneumoniae. From among our strains 5 were susceptible to serum bactericidal activity and 5 were found to be resistant. We selected two serum concentrations (15 and 35%) to test against susceptible strains and two (55 and 75%) to test against resistant strains in combination with the minimum inhibitory concentration (MIC), 1/2MIC and 1/4MIC of ofloxacin. The results show a slight variability among the tested strains depending on microbiological characteristics of single strains, however, the serum + ofloxacin combination was advantageous. Only one exception was observed: a resistant strain that had an increased survival percentage against ofloxacin and serum in combination.

Different expression of HLA class I antigens in liver of children with chronic hepatitis B, evaluated by immunohistochemical method.

Studies on the quantitative expression of the Major Histocompatibility Complex (MCH) in hepatocytes chronically infected by Hepatitis B Virus (HBV) report that an increased expression of these antigens could be related to a good immunological response. In the present work we analyze the expression of the MCH antigens in cryostatic sections of liver biopsies taken from subjects (19 children) with various forms of HBsAg positive chronic hepatitis. A high expression of HLA class I antigens and a high degree of hepatocyte necrosis was evident in Chronic Active Hepatitis (CAH) and Chronic Lobular Hepatitis (CLH). On the contrary, subjects with histological diagnosis of Chronic Persistent Hepatitis (CPH) showed a low expression of such antigens. There was however, the difference that in subjects with high hepatic cytolysis and high expression of HLA class I antigens, serum HBV-DNA was clearly present in almost all the cases with CAH, but not detectable in all cases with CLH. The expression of HLA class II antigens and of Beta2 microglobulin was the same in all 19 cases. All cases with HBV-DNA positivity with high class I antigen expression had active hepatitis which seems to suggest that all attempts at viral clearance on the part of the immune system have been in vain. We hope our paper will be an additional parameter for evaluating the course of hepatitis during Interferon treatment.

Hepatitis G virus infection in intravenous drug users with or without human immunodeficiency virus infection.

BACKGROUND/AIMS: To evaluate the HGV infection prevalence in a group of intravenous drug users with or without human immunodeficiency virus coinfection. METHODOLOGY: We studied 57 patients (48 males and 9 females) who were either previous or still ongoing intravenous drug users. Thirty-seven patients were HIV+ve, 55 patients were anti-HCV+ve and 3 patients were HBsAg chronic carriers. Patient sera were tested for HGV-RNA, anti-E2, qualitative and quantitative HCV-RNA as well as for HCV genotypes. Moreover, the ALT level was checked in the serum sample of each patient. RESULTS: We found a high prevalence (35/57; 61.4%) of HGV infection in our patients. HGV-RNA was detected in 16 out of the 57 intravenous drug users (28%). In particular HGV-RNA was positive in 12 out of the 37 HIV+ve patients (32.4%) and in 4 out of the 20 HIV-ve patients (20%). Anti-E2 were detected in 19 out of the 57 patients (33.3%) with greater prevalence among HIV-ve subjects (12/20; 60%) compared to HIV+ve group (7/37; 18.9%). This resulting difference was statistically significant (P < 0.05). All HGV-RNA+ve/anti-E2+ve patients were anti-HCV/HCV-RNA+ve and none of our patients were anti-E2+ve/HGV-RNA+ve at the same time. Significant differences were not found between HGV-RNA+ve and HGV-RNA-ve patients as far as clinical and virological data are concerned. CONCLUSIONS: The prevalence of HGV infection in intravenous drug users proved to be high especially in the HIV+ve group. Moreover HGV was associated with HCV in all our cases. The actual clinical impact of HGV infection remains unclear since HGV does not seems to influence the biochemical, virological or histological alterations caused by HCV infection.

[Use of vancomycin in the treatment of severe Staphylococcus aureus infection. Description of 3 cases]. / Impiego della Vancomicina nel trattamento di sepsi gravi da Staphylococcus aureus. Descrizione di 3 casi.

In recent years, the diffusion of antibiotic multiresistant staphylococcus strains in hospitals (especially aureus and epidermis) has created serious drawbacks as regards the treatment of severe septic forms and the systemic spread of these bacteria. The results of endovenous vancomycin treatment in three cases of sepsis with secondary localisations (endocarditis, osteomyelitis, pneumonia) caused by gram positive staphylococcus aureus are examined. The pharmaceutical was found to be effective in all cases and free from significant side effects.

[Bacterial, mycotic and protozoal cholangitis in childhood]. / Le colangiti batteriche, micotiche, protozoarie in età pediatrica.

The Authors present the cases of cholangitis in childhood observed in the Institute of Infectious diseases of Genoa from 1973 to 1982. Cholangitis rarely starts by alone, whereas it appears usually in association with hepatic underlying disease. In childhood the symptomatological triad (fever, jaundice, pain) is infrequent: only jaundice is a common sign of disease. Polymicrobial aetiology of cholangitis is very usual, but Streptococci and E. coli are the aetiological agents most frequently observed; sometimes also anaerobic organsimee, fungi and protozoa cause cholangitis.

[Hepatic duct hypoplasia or Alagille-Odièvre disease]. / La ipoplasia duttale epatica o malattia di Alagille-Odièvre.

Five children from one to seven years of age with intrahepatic ductular hypoplasia are presented. Clinical and biochemical characteristics of the disease are specifically considered as well as differential diagnosis. In three patients a severe hemolytic anemia, only partially corrected with vitamine E, was present. All subjects received continuous cholestyramine therapy. Variable follow up from nine months to seven years demonstrated persistent intrahepatic cholestasis with hypercholesterolemia in two cases, clinical and biochemical improvement in one case. One child died two years and six months after diagnosis was made an one patient was lost to follow up. The Authors confirm the literature clinic, diagnostic and therapeutic data concerning ductular hypoplasia, while, on the basis of their experience, the prognosis seems poor also in some cases of syndromic ductular hypoplasia.

[Hepatic involvement in pediatric neoplasms]. / Interessamento epatico in neoplasie infantili.

The liver is an organ which appears particularly susceptible to undergo a series of toxic effects related to the presence of a neoplastic process and the modalities adopted for its treatment. However, the phenomena of liver toxicity which are encountered at diagnosis and during treatment of pediatric neoplasias, are numerous and of complex nature, quite often of difficult explanation. The authors have distinguished: - primitive benign and malign tumors of the liver; - toxic effects dependent from the neoplastic infiltration of tumors arising in extrahepatic sites; - toxicity not related to neoplastic infiltration. Several cases of different solid neoplasias are described, which exemplify the several modes by which the liver can be affected by tumors, and the possible etiopathogenetic mechanisms are searched for. In addition, the authors refer on the aspects of liver toxicity observed in a series of 44 children affected by acute lymphoblastic leukemia. They distinguish a toxicity which precedes treatment; - a toxicity which arises during the induction-consolidation phase of therapy; - a toxicity which comes out during maintenance with Methotrexate and 6-mercaptopurine, this latter strictly correlated to the continuous administration of these two drugs. Finally, the complicated correlation between acute hepatitis and leukemia is discussed, and the attention is focused particularly on the possible antileukemic affect of the acute liver infection, which is capable to determine, in few well described cases, a complete, although transient disease remission.

[Kawasaki disease: a new pediatric nosological entity]. / Malattia di Kawasaki: una nuova entità nosologica pediatrica.

Kawasaki disease (KD) is a new, well characterized pediatric syndrome. In this work the last epidemiologic, diagnostic and clinical data are pointed. Especially the heart-disease and its monitoring and therapy are studied. Our casuistry (5 cases in 4 years) is also presented. The international literature and our clinical experience suggest that KD is more spread than we think and therefore in needs to be studied carefully by the pediatricians.

[Behavior of hemagglutination-inhibiting antibodies against measles and rubella in a group of children with chronic hepatitis]. / Comportamento del tasso di anticorpi emoagglutinoinibenti antimorbillo ed antirubeola in un gruppo di bambini affetti da epatite cronica

The Authors studied the amount of anti-measles and anti-rubella heteroantibodies during chronic hepatitis and the possible role of these antibodies in eliciting and maintaining the hypergammaglobulinemic picture, characteristic of this morbid condition. The results they obtained in an almost exclusively pediatric case-list (37 cases) show, whenever the contact with these viruses (measles and rubella) occurred, a percentage of subjects with comparatively higher levels among chronic liver patients in comparison with control patients, of the same age. The percentage of subjects with previous rubella infection and hemagglutination-inhibiting antibody levels higher than 1:256 is about 45% among chronic liver patients, compared with 13% in healthy subjects. As far as measles virus is concerned the percentage drops from 11% to 4%. The most reliable hypotheses to explain this interesting phenomenon, which, however, does explain only partially, and concerning some cases only, the entity of the hypergammaglobulineamia, are set forth briefly.

[Behavior of specific antibodies against hepatitis B surface antigen in children with acute and chronic hepatitides in healthy carriers and in various co-habitants of chronic hepatitis patients]. / Comportamento degli anticorpi specifici verso l'antigene di superficie del virus epatitico b nelle epatiti acute e croniche infantili, in portatori sani ed in alcuni conviventi con epatitici cronici

The Authors studied the behaviour of ABsAb in a pediatric case-list made up of 8 cases of virus B acute hepatitis, and 63 cases of chronic hepatitis in different evolutive phases: besides, this investigation was extended to 48 healthy carriers (29 of whom bioptically confirmed) and 35 cases of cohabitants with HBsAg-positive hepatic chronic patients. In acute hepatitis the antibody pattern, even if delayed in time, mimics the modalities of the organic response against exogenous stimulations, therefore it constitutes an index of past disease and recovery. In chronic hepatitis (both HBsAg-positive and negative) the specific antibody to the surface antigen is present only at a low percentage (27%) and generally at low titres. In healthy carriers, bioptically ascertained, it is practically absent as to suggest more careful consideration when it turns out present (pseudo-carriers?), while in the cohabitants with virus B patients, especially if chronic, along with HBsAg detection, it consitutes an indispensable element for their classification in patients, ex-patients, not infected and healthy carriers. A very interesting finding, requiring further confirmation, is the unusual behaviour of these antibodies in some cases of relapsed chronic hepatitis.

[Liposomal Amphotericin B for treatment of acute phase and secondary prophylaxis of visceral leishmaniasis in a HIV positive patient] / L'utilizzo dell'Amfotericina B liposomiale nel trattemento della fase acuta e nela profilassi secondaria della Leishmaniosi viscerale in un paziente HIV positivo.

The authors describe a clinical case of an HIV+, HBV+ and HCV+ 46-year-old male patient, with a history of drug abuse of intravenous heroin, admitted to their attention for high remittent fever (39 C), weight loss and severe dysphonia. The increasing severity of dysphonia had required a fiberlaryngoscopic examination which allowed a diagnosis of hypertrophy of vocal chords. The Wright-Giemsa stain performed on vocal chord biopsy evidenced Leishmania infantum. The same protozoon was subsequently also revealed in bone marrow aspirate. The patient underwent a course of therapy with Amphotericin B deoxycolate (0.5 mg/kg) which had to be interrupted due to insurgence of diffuse petechiae and switched to Amphotericin in cholesterinic suspension (2.5 mg/kg every 21 days). After three months, insurgence of high fever related to the infusion induced the start of therapy with liposomal Amphotericin B (3 mg/kg every 28 days) which led in 4 weeks to a complete clinical remission. Prophylaxis with liposomal Amphotericin B is continuing and remission has persisted for 40 months. This case report shows the importance of liposomal Amphotericin B therapy in order either to obtain clinical remission of visceral leishmaniasis or, in secondary prophylaxis, to reduce the risk of the disease's recurrence.

Chronic autoimmune neutropenia due to anti-NA1 antibody.

A 12-month-old child neutropenic since the age of 8 months, was referred to our institute for a sepsis from Candida albicans. On exploring the cause of neutropenia, an anti-NA1 antibody could be detected in the patient's serum. This antibody seemed to be responsible for the neutropenia because the child's PMN type was NA1+. The reactivity of the autoantibody with the patient's own granulocytes was confirmed by direct and indirect immunofluorescence studies performed on blood and marrow cells. A reduced number of T lymphocytes with poor PHA responsivity has been interpreted as the possible cause of the autoimmune disease. Steroid therapy did not cure the neutropenia but the child's general condition improved.

Evaluation of ceftazidime in the treatment of 80 infectious episodes in compromised children.

The efficacy of ceftazidime in the treatment of infections in compromised children was evaluated in 80 such episodes occurring in 64 patients with various underlying diseases. Among the patients treated, 9 were newborns with severe neonatal distress, 21 were children with cancer and neutropenia, 8 were surgical patients, 22 had cystic fibrosis and 4 were suffering from meningitis. The following types of infections were treated: 19 bacteriologically documented and 8 possible septicemias (the latter only in newborns and neutropenic cancer patients); 2 severe upper respiratory tract infections in cancer patients; 8 soft tissue or skin infections; 1 cholangitis; 1 pneumonia; 1 osteomyelitis; 1 mediastinitis; 35 infectious exacerbations of underlying pulmonary disease in cystic fibrosis patients; and 4 meningitides. In almost all cases ceftazidime was administered intravenously in combination with an aminoglycoside. In 2 cases it was also given intrathecally or intraventricularly. Bacteriological documentation was achieved in 70 out of 80 episodes. A successful outcome was obtained in 79% of the cases with slight and statistically nonsignificant differences between groups of patients with different etiological patterns in terms of prevalence of gram-positive microorganisms. Tolerance of the treatment was uniformly good, only one patient showing a mild, transient transaminase elevation.

Long-term administration of aerosolized pentamidine as primary prophylaxis against Pneumocystis carinii pneumonia in infants and children with symptomatic human immunodeficiency virus infection. The Italian Pediatric Collaborative Study Group on Pentamidine.

SUMMARY: We assessed the long-term feasibility, safety, and tolerability of two regimens of aerosolized pentamidine (AP) as primary prophylaxis of Pneumocystis carinii pneumonia (PCP) in a large sample of infants and children with symptomatic HIV infection in 21 pediatric departments. One hundred forty children were assigned to receive 60 mg every 2 weeks (n = 60) or 120 mg every 4 weeks (n = 80) of AP, delivered by the ultrasonic nebulizer Fisoneb under the supervision of trained personnel. Children underwent monthly clinical and laboratory controls for toxicity and/or development of PCP for an 18-month period. Baseline characteristics were similar in the two treatment groups. The median age was 5 years. The feasibility of administering AP was excellent in 84 (60 percent) and good in 38 (27 percent) children. All children aged <2 years showed excellent or good feasibility. Long-term compliance was good with both regimens. No child had severe adverse reactions requiring discontinuation of the treatment. Cough, sneezing, and bronchospasm were the most frequent side effects occurring, respectively, in 12, 3.7, and 0.7 percent of the 60-mg treatments and in 19.1, 6. 1, and 2.8 percent of 120-mg treatments (p < 0.05). Their incidence was not different in children younger or older than 5 years. Two episodes of PCP were observed in the group receiving 120 mg monthly, whereas none of the 60 children in the biweekly schedule had PCP (p = 0.20). AP can be safely administered to very young children with few adverse side effects.

Immunogenicity of a killed E. coli 0111:K58 vaccine administered orally to children.

A killed E. coli 0111:K58 vaccine was administered by the oral route to 16 children ranging from 3 months to 7 years of age. The antibody response was measured at different times after the vaccination through the titration of agglutinating antibodies in serum and in fecal extracts, and the detection of specific IgA immunoglobulins in the intestinal content. All vaccines developed antibody response detectable both inserum and in fecal samples. Coproantibodies tended to appear earlier and to attain higher titers than circulating antibodies; they were all least in part IgA immunoglobulins, since the content of specific IgA in the fecal extracts was proportional to the agglutinating titer.

Level of human immunodeficiency virus DNA in peripheral blood mononuclear cells correlates with efficacy of antiretroviral therapy.

A novel colorimetric assay was developed and validated for accurate quantitation of human immunodeficiency virus (HIV) DNA in peripheral blood mononuclear cells (PBMCs). We tested 318 sequential samples from 56 subjects, 53 of whom were undergoing dual or triple therapy. Patients were considered responders when viremia levels were below 5, 000 HIV RNA copies/ml. The mean DNA copy numbers for untreated and responder subjects were similar (72 and 75, respectively), while it was 4.54-fold higher for nonresponders (339). This report provides strong evidence that HIV DNA levels in PBMCs correlate with therapeutic efficacy and suggests that DNA quantitation is a useful tool to monitor the decay of the HIV reservoir toward disease remission, especially when viremia is undetectable.