[Susceptibility rate to tigecycline and antibiotic-resistance among Klebsiella pneumoniae strains isolated in Intensive Care Unit]. / Suscettibilità alla tigeciclina e antibiotico-resistenza in ceppi di Klebsiella pneumoniae isolati in Unità di Terapia Intensiva.

Antibiotic resistance in Klebsiella pneumoniae strains is an increasing problem in a lot of hospitals. It is a public health emergency because it relates with high mortality rate among patients in Intensive Care Unit (ICU). From 1/1/2009 to 31/08/2010, in ICU of SS Annunziata Hospital of Taranto, 140 isolated Klebsiella pneumoniae strains were detected. The strain identification and antimicrobial susceptibility testing were performed using a Vitek2 automated system. These isolate showed a low level of susceptibility to levofloxacin (3.4%), ciprofloxacin (6.2%), ceftazidime (2.8%) and piperacillin/tazobactam (8%). We reported also that the 10% and 13.9% of them were susceptible to meropenem and imipenem. An anti-Klebsiella pneumoniae activity in vitro to tigecycline was present in 64.6% of isolates while almost all strains (56/58) tested to colistin were susceptible. In order to our data of worryng high multiclass drug resistance including tygecicline, it needs to apply appropriate measures of surveillance and antibiotic prescription to avoid rapid spread of these mutiresistant strains in other areas.

Varicella zoster virus encephalitis during treatment with anti-tumor necrosis factor-alpha agent in a psoriatic arthritis patient.

The introduction of targeted immunotherapies has greatly improved the therapeutic options of several inflammatory diseases such as psoriatic arthritis. However treatment-related opportunistic infections and viral reactivations may still occur. We describe a case of varicella zoster virus (VZV) encephalitis due to the reactivation of latent VZV infection during a long therapy with the anti-tumor necrosis factor-alpha (TNF-alpha) drug Adalimumab. The low incidence of VZV encephalitis in patients treated with biological agents does not justify VZV serological screening in these subjects, but careful monitoring of the patients is recommended to recognize early signs and symptoms of herpes zoster to start prompt antiviral therapy to prevent associated complications.

[Encephalitis associated to novel influenza A virus infection (H1N1) in two young adults]. / Encefalite associata al virus influenza A (H1N1) in due giovani adulte.

At today, neurologic desorders associated with novel influenza A (H1N1) virus were reported only in children but not in adult. We report two cases of encephalitis associated to H1N1 virus infection occurred in females of age 28 and 37 years. In both cases disease was less severe without neurologic sequelae. In one case PCR analysis of CSF sample showed a positivity for HSV1. Novel influenza A (H1N1) viral RNA by real time PCR was detected in nasopharyngeal specimens.

A Cluster of Cryptic Plasmodium falciparum Malaria in African Migrants in Southern Italy, October 2017.

Background: Italy was declared malaria free by the World Health Organization in 1970. Despite this, nonimport malaria cases are on the increase in Italy and throughout the Mediterranean area. In Italy, in the period between 2011 and 2015, seven cases of locally acquired malaria have been reported, including one introduced case of Plasmodium vivax; moreover, the last certain case of introduced malaria (by P. vivax) has been reported in Tuscany in 1997. No case of introduced malaria from Plasmodium falciparum has been reported in Italy since 1970. Case Presentation: A cluster of four cryptic P. falciparum malaria cases were ascertained in migrant farm workers (three from Morocco and one from Sudan) in Apulia (southern Italy) with clinical onset between September 20 and 27, 2017. None of the patients reported a history of a recent trip to malaria-endemic areas or hospitalization or other risk factors. Typing of malaria was also confirmed using molecular biology methods in two different laboratories. There were no cases of severe malaria in our four patients, and only one in need of transfusion. All patients were discharged cured after being treated with mefloquine due to the unavailability of other antimalarials. Conclusions: In recent years, numerous reports of locally acquired malaria have been made in southern Europe. The cases described in this article represent the first cluster of malaria caused by P. falciparum in Europe. Today, clinical presentation in the diagnosis of malaria is more important than ever, since epidemiological criterion cannot be considered unfailing. The mode of transmission has not been proven and further biological and entomological studies are necessary to define our case as cryptic or confirm the presence of mosquitoes capable of transmitting P. falciparum and/or the capacity of Anopheles labranchiae, An. superpictus, or An. plumbeus to transmit it on Italian territory.

[No floroquinolone resistance in non typhoidal salmonellas from hospitalized persons in an endemic area of Apulia, Italy]. / Nessuna resistenza ai fluorochinolonici in salmonelle non tifoidee isolate da persone ospedalizzate in un'area endemica della Puglia.

Non typhi-salmonella is the most common cause of hospitalization or death associated with acute diarrhea. It is usually a self limiting disease and antibiotic therapy is not required, but in immunocompromised people it is essential. Increasing antimicrobial resistance in salmonella, in future, would limit the therapeutic options. During 2002, 198 persons were hospitalized for acute gastroenteritis. The 55% of cases were female, the age ranged between 4 and 94 years and the 25% of them were > 60 years old. The 58.5% of hospitalizations occurred between June and October. Non-typhi salmonella was isolated in the stool of 49 persons, with a rate of hospitalization of 24.7% respect to other causes of gastroenteritis. The incidence of resistance that was defined as resistance to one or more drugs was 14.3%. Only one non-typhi salmonella showed a multiple resistance (> four drugs). Among all antibiotics tested, only the fluorquinolones showed a susceptibility in vitro in all strains. Non typhoidal Salmonellosis is a public healt problem in the world and it will be important to restrict the use of antibiotics in medicine and veterinary to reduce the spread of multiresistant strains.

[Myocardial infarction in the course of antiretroviral therapy with protease inhibitor]. / Infarto miocardico in corso di terapia antiretrovirale con inibitore della proteasi.

The use of protease inhibitors (PIs) in the antiretroviral therapy (ART) of HIV-1 infection has reduced the rate of morbidity and mortality; but, unfortunately, this therapy has several side effects and a long term toxicity. Unexpected lipid abnormalities and cardiovascular complications are observed. We report a case of myocardial infarction in a young man HIV-1 positive patient without a history of metabolic disorders and cardiovascular pathologies undergoing PI treatment. The new ART without PI was not suppressive, while hypertriglyceridemia value improved by omega 3 fatty acids use. Our opinion is to continue ART with PI and to correct lipid abnormalities with the use of antidislipidemic drugs instead to change a demonstrated suppressive ART.

[Epidemiologic and clinical parameters in hospitalized patients with novel Influenza A (H1N1) in Taranto province, Italy]. / Caratteristiche epidemiologiche e cliniche dei pazienti ospedalizzati con Influenza A (H1N1) nella provincia di Taranto, Italia.

The global spread of novel influenza A (H1N1) led the World Health Organization to declare a pandemic on June 11, 2009. Our study aimed to describe the epidemiologic and clinical parameters of hospitalized patients during the pandemic. Fifty-one persons with suspected influenza A H1N1 were hospitalized. Thirty-two of them (14 male and 18 female) were positive for novel influenza A (H1N1) viral RNA by real time PCR in nasopharyngeal specimens. Of those who tested positive, 46.8% (15 patients) were aged between 25-49 years and only 9.3% (3) were over 65 years old. Nineteen of the 32 presented a co-morbidity. The mean duration of hospitalization was 6.5 days (range 3-19). An influenza complication was presented by 68.7% of patients (all of them older than 65 years), which in most cases was pulmonary disease (18 bronchopneumonia, 2 interstitial pneumonia). Four patients required mechanical ventilation in Intensive Therapy Care. One patient died of a concomitant myopericarditis. Of the patients with influenza complications, 60% presented co-morbidity conditions. Neurologic complication (encephalitis) occurred in two young women; prognosis was good and without neurologic sequelae. In conclusion, our data do not show a correlation between gender and risk of hospitalization or influenza complication. The presence of co-morbidity does not increase the risk of pulmonary complication, which is more frequent among young adults.