Chagas disease in Italy: breaking an epidemiological silence.

Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.

Hookworm infection in infants: a case report and review of literature.

BACKGROUND: Hookworm infections (Necator americanus, Ancylostoma duodenale) are common in rural areas of tropical and subtropical countries. Human acquisition results from direct percutaneous invasion of infective larvae from contaminated soil. Overall, almost 472 million people in developing rural countries are infected. According to simulation models, hookworm disease has a global financial impact of over US$100 billion a year. Hookworm infection in newborn or infancy is rare, and most of the cases reported in literature are from endemic countries. Here, we describe the case of an infant with an Ancylostoma duodenale infection and review the literature currently available on this topic. CASE PRESENTATION: An Italian 2-month-old infant presented with vomit and weight loss. Her blood exams showed anemia and eosinophilia and stool analysis resulted positive for hookworms' eggs, identified as Ancylostoma duodenale with real time-PCR. Parasite research on parents' stools resulted negative, and since the mother travelled to Vietnam and Thailand during pregnancy, we assumed a transplacental transmission of the infection. The patient was treated successfully with oral Mebendazole and discharged in good conditions. DISCUSSION: Hookworm helminthiasis is a major cause of morbidity in children in the tropics and subtropics, but rare in developed countries. Despite most of the patients is usually asymptomatic, children are highly exposed to negative sequelae such as malnutrition, retarded growth and impaired cognitive development. In infants and newborns, the mechanism of infection remains unclear. Although infrequent, vertical transmission of larvae can occur through breastfeeding and transplacentally. Hookworm infection should be taken into account in children with abdominal symptoms and unexplained persistent eosinophilia. The treatment of infants infected by hookworm has potential benefit, but further studies are needed to define the best clinical management of these cases.

[The natural history of Still's disease. Description of a clinical case with repeated recurrences and long remission periods]. / La storia naturale della malattia di Still. Descrizione di un caso clinico a decorso policiclico e con lunga remissione.

A case of Still's disease is presented that demonstrates the uncertain prognosis and the duration of the treatment required to prevent recurrences. The importance of frequent check-ups is also emphasised.

[Pseudohypoparathyroidism. Analysis of a clinical case with late development]. / Pseudoipoparatiroidismo. Analisi di un caso clinico ad evoluzione tardiva.

A case of pseudohypoparathyroidism of characteristic phenotype and metabolism is described. The condition was diagnosed at over 50 years of age following the appearance of hypocalcaemia and calcification of basal ganglia which responded quickly to treatment with vitamin D and orally administered calcium. This case gives the opportunity to describe a rare hereditary disease and discuss which mechanisms triggered off the symptomatology: mechanisms which involve PTH, the action of which is still not fully known.

[Cutaneous tuberculosis with multifocal visceral involvement]. / Tubercolosi cutanea con coinvolgimento viscerale multifocale.

The case of a young Senegalese man who developed a form of cutaneous tuberculosis associated with a disseminated disease, successfully treated with appropriate antitubercular chemotherapy is reported. We found Mycobacterium Microti in the cutaneous ulcers, the only organism isolated after many cultural and microscopical examinations of different exudates and tissues. This mycobacterium was considered up to now to be pathogenic to rodents, but not man. Its possible pathogenicity to man (under certain situations) is also suggested, and it is expected that this possibility will be supported by other reports in the near future. In addition, stress is laid on the problems of diagnosis and classification of the cutaneous tuberculosis, so uncommon in the Western Hemisphere, and its possible association with leprosy.

[Effect of some anticoagulant drugs on granulocyte capillary migration]. / Effetto di alcuni anticoagulanti sulla migrazione dei granulociti da capillare.

We have investigated the effect of four anticoagulant drugs (Calbiochem Heparin, Liquemin Roche, EDTA and Na citrate) on polymorphonuclear granulocyte capillary migration to evaluate a possible modification induced by these drugs on migration function. We can state that any modification is induced by these drugs on granulocyte capillary migration in vitro.

Effects of timolol maleate on tear flow in human eyes.

Lacrimal function was studied in 30 patients treated for glaucoma, with 0.25% timolol eye drops. Rose bengal and fluorescein staining disclosed punctate epithelial defects in 11 eyes after one week. During the following weeks there defects disappeared spontaneously in most eyes. Schirmer tests (I and II), tear lysozyme and pre-corneal film break-up time were significantly decreased by the treatment, while tear immunoglobulins were unimpaired. The authors conclude that topical timolol treatment decreases tear production. This effect is quantitatively limited and does not appear dangerous for normal eyes, although it may become so for eyes with an originally low lacrimal secretion.

[Sister chromatid exchanges induced in human lymphocyte chromosomes by trifluralin, atrazine and simazine]. / Sce (sister chromatid exchanges) indotti nei cromosomi dei linfociti umani da trifluralin, atrazina e simazina.

Many epidemiological and experimental "in vivo" studies have proved in recent years the carcinogenic properties of herbicides. In order to evaluate the "in vitro" action on the human DNA of Trifluralin, Atrazine and Simazine (active principles of herbicides Treflan and Fogard S respectively) the authors have studied the rates of SCE in cultures of human lymphocytes exposed to different concentrations of a solution 1 ppm of the substances. Trifluralin and Simazine, but not Atrazine, increase SCE per cell, with statistical significance, in the cultures with the highest concentrations of these substances. (SCE per cell: Trifluralin 5.27 +/- 1.38, Simazine 5.09 +/- 1.19, Control 3.51 +/- 1.14).

Effect of single oral dose of phenobarbitone on lymphocyte blastogenic response in man.

A single oral dose of phenobarbitone 1.5 mg kg-1 was given to 18 normal subjects to evaluate the effects on lymphocyte function. Serum barbiturate concentrations and lymphocyte blastogenic response to three mitogens (PHA, Con A, PWM) were tested before and at 2, 12 and 36 h after drug administration. A serum barbiturate plateau of about 2 microgram ml-1 was maintained from 2 to 36 h. Lymphocyte blastogenesis was reduced with barbiturate compared with controls. However, the reduction was significant only at 36 h (P < 0.01).

[Effects of phototherapy with blue light on chromosomes from human lymphocytes]. / Effetti della fototerapia a luce blu sui cromosomi dei linfociti umani.

The dangerous effects of phototherapy have been matter of discussion in recent years. In order to evaluate its in vitro action on the human DNA, the authors have performed the karyotypic analysis on 20 cultures of lymphocytes. In different times 16 cultures have been exposed to the action of a "blue light" fluorescent lamp, commonly used for the treatment of neonatal jaundice. The authors have not evidenced any morphological or numerical change of the karyotype in any of the cultures.

[Evaluation of the effect of cloxacillin on human lymphocyte chromosomes through the study of karyotypic changes and sister chromatid exchanges]. / Valutazione dell'effetto della cloxacillina sui cromosomi di linfociti umani attraverso lo studio delle alterazioni cariotipiche e degli sce (sister chromatid exchanges).

The aim of this work was the evaluation of the possible mutagenic effect of an antibiotic, the Cloxacillin. Therefore the authors have performed the analysis of the chromosomal alterations and the study of the SCE (Sister Chromatid Exchanges) induced with the exposition of cultures of lymphocytes to different concentrations of this drug. The work reveals that Cloxacillin induces chromosomal alterations at high concentrations, while at concentrations similar to its therapeutic levels the drug does not seem to interfere with human DNA.

Does the tuberous sclerosis complex include intracranial aneurysms? A case report with a review of the literature.

BACKGROUND: Tuberous sclerosis is a protean, genetically determined disease that may involve any organ or tissue and lead to a great number of symptoms and clinical features. OBJECTIVE: Diagnosis can be very difficult in cases with incomplete manifestations (formes fruste) lacking the classic signs of the disease. MATERIALS AND METHODS: We report a case fulfilling the diagnostic criteria for tuberous sclerosis (shagreen patches, hypomelanotic macules, renal cysts and angiomyolipomas, and "migration tracts" in the cerebral white matter) in association with a giant intracranial aneurysm, but lacking mental retardation, epilepsy and facial angiofibroma. RESULTS: Fourteen other cases of tuberous sclerosis and intracranial aneurysms, all but one without any clear sign of polycystic kidney disease, were found in the literature. CONCLUSION: We suggest that vascular dysplasias in general and aneurysms (mainly intracranial) in particular can be added to the other non-primary diagnostic features for the clinical diagnosis of tuberous sclerosis.