Plasmodium vivax exflagellated microgametes in human peripheral blood: a potential diagnostic dilemma.

Both malaria and relapsing fever Borrelia are infectious diseases characterized by fever, headache, myalgia, hepatosplenomegaly and tendency to relapse. Exflagellation of microgametocyte in malarial parasites is seen only in the definitive host, i.e., mosquitoes. Here we report an unusual case of a 23-year-old man who presented Plasmodium vivax infection with multiple exflagellated microgametes in the peripheral blood smear.

Gastrointestinal basidiobolomycosis in a patient suffering from duodenal ulcer with perforation: First case report from Italy.

Gastrointestinal basidiobolomycosis (GIB), an unusual fungal infection caused by the fungus Basidiobolus ranarum, is rarely reported in the medical literature. GIB is difficult to diagnose because its clinical presentation is non-specific and has no identifiable risk factors. We report here the first case of GIB diagnosed in Italy in a patient suffering from a duodenal ulcer with perforation. The patient was successfully treated with itraconazole. The absence of non-specific signs and symptoms of GIB may delay a definitive diagnosis and treatment. A microbiological investigation should always be requested in order to reach a rapid and definitive diagnosis and to rule out other intestinal diseases.

Direct identification of microorganisms from positive blood cultures using the lysis-filtration technique and matrix assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS): a multicentre study.

Microbial identification from blood cultures is essential to institute optimal antibiotic therapy and improve survival possibilities. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has been successfully applied to identify bacteria and yeasts from positive blood cultures broths. The aim of this multicentre study was to evaluate the reliability of the lysis-filtration technique associated with MALDI-TOF MS to directly identify microorganisms from 765 positive blood cultures collected in six Italian hospitals. Overall, 675/765 (78.1%) blood isolates were correctly identified at the species level, with significant differences between Gram-negative and Gram-positive bacteria (92.6%, and 69.8%, respectively). Some difficulties arise in identifying Streptococcus pneumoniae, Staphylococcus aureus, yeasts and anaerobes. The lysis-filtration protocol is a suitable procedure in terms of performance in identifying microorganisms, but it is quite expensive and technically time-consuming since the time of filtration is not regular for all the samples. The application of the MALDI-TOF MS technique to the direct microbial identification from positive blood cultures is a very promising approach, even if more experience must be gained to minimize errors and costs.

Diagnosis of Respiratory Syncytial Virus (RSV) infection in children by Respiratory Panel utilized during the COVID-19 pandemic.

BACKGROUND: In the months of October and November 2021, there was throughout Italy and in our specific case in the area of Lucca and Versilia, a disturbing increase of SARS-CoV-2 infections and cases of Respiratory Syncytial Virus (RSV) in new-borns. The aim of this paper is to compare the cases of RSV infection diagnosed in recent years to the cases recorded during the SARS-CoV-2 pandemic to November 2022. MATERIALS AND METHODS: The study consisted of evaluating the results of requests for RSV diagnosis from 2015 to November 2022, using molecular biology techniques. RESULTS: The data obtained show that the number of cases of RSV infection in children during the winter season had a constant trend from 2015 to 2019. From November 2020 to February 2021 there were no cases of RSV respiratory infections. Starting from September 2021, on the other hand, there was a resumption of cases of RSV infections in conjunction with an increase in the number of children affected by COVID-19. From January 2022, after a peak in cases of SARS-CoV-2 infection, there has been a decrease in RSV infections. From September 2022 to November 2022, there was no increase of cases of RSV infections in new-borns but on the contrary, there was a trend in respiratory infections comparable to the pre-pandemic period. CONCLUSION: The data that emerged from the study conducted, show the onset of an outbreak of RSV in new-borns. This incidence is linked to the implementation of rigorous non-pharmacological public health interventions in 2020, aimed at combating COVID-19 infection. The use of the molecular panel made it possible to identifying the responsible agent and highlighting the most suitable clinical and therapeutic path.

Effects of semaglutide on cardiovascular risk factors and eating behaviors in type 2 diabetes.

AIMS: Aim of the present study was to evaluate the impact of once-weekly semaglutide on different end-points indicative of metabolic control, cardiovascular risk, dietary behavior, and treatment satisfaction in T2DM. METHODS: This was a retrospective observational study conducted in a diabetes clinic. Changes in HbA1c, fasting blood glucose (FBG), weight, blood pressure, lipid profile, and number of antihypertensive drugs at 32 weeks (T1) after the first prescription of semaglutide (T0) were analyzed. Furthermore, at T1 patients were asked to fill-in the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the Control of Eating Questionnaire (COEQ). RESULTS: Overall, 104 patients were identified (mean age 63.6 ± 10.4 years, 58.7% men, diabetes duration 12.7 ± 8.7 years). After 32 weeks of treatment with semaglutide, HbA1c levels were reduced by 1.38%, FBG by - 56.53 mg/dl, weight by 6.03 kg. Systolic and diastolic blood pressure, total, HDL-, LDL-, and non -HDL cholesterol, and triglycerides significantly improved. The number of glucose-lowering and antihypertensive drugs also decreased. At T1, DTSQ score was 32.23 ± 1.44, whereas COEQ indicated low levels of hunger and good control of eating. CONCLUSIONS: The study documented benefits of semaglutide on metabolic control and multiple CV risk factors, simplification of therapeutic schemes and high satisfaction with diabetes treatment, and eating behaviors indicative of healthy diet and reduced food intake.

Predictive Low Glucose Suspend Algorithm in Real Life: A Five-Year Follow-Up Retrospective Analysis.

AIM: Sensor-augmented pumps with predictive low glucose suspend function (PLGS-SAP) help patients avoid hypoglycemia and improve quality of life: in this retrospective study, we investigated long-term effects of PLGS-SAP on metabolic outcomes, acute and chronic diabetic complications, in particular cardiovascular events. MATERIALS AND METHODS: One hundred thirty-nine adults with type 1 diabetes (T1D) treated for more than 10 years with continuous subcutaneous insulin infusion (CSII) were followed for 5 years; 71 (Group 1) started to use PLGS-SAP, and 68 (Group 2) maintained on their non-PLGM insulin pump. Glucose control measures (hemoglobin A1c [HbA1c], acute diabetic complications), clinical outcomes (body mass index [BMI], arterial hypertension, dyslipidemia), chronic diabetes-related complications, and device utilization (continuous glucose monitoring utilization, use of temporary basal rates or special boluses, carbohydrate counting usage) were assessed. RESULTS: The reduction of HbA1c was significant in Group 1 (from 7.5% ± 1.1% to 7.0% ± 1.0%, P = .02), while in Group 2 it did not reach statistical significance (from 7.5% ± 1.1% to 7.4% ± 0.9%, P = .853). BMI increased significantly in Group 2 (from 25.3 ± 2.8 to 25.7 ± 3.4, P < .001), but not in Group 1 (from 25.2 ± 3.5 to 25.2 ± 2.8, P = .887). There were no statistically significant differences in occurrence of acute diabetes complications, other clinical outcomes, prevalence of diabetes-related complications, or device utilization between the groups. CONCLUSIONS: In our five-year follow-up experience with T1D CSII users, PLGS-SAP has resulted efficient in improving metabolic control and maintaining the body weight.

Evaluation of the commercial AD fosfomycin test for susceptibility testing of multidrug-resistant Enterobacterales and Pseudomonas aeruginosa.

OBJECTIVES: To compare fosfomycin susceptibility testing with the commercial agar dilution (AD) test, AD Fosfomycin (Liofilchem, Roseto degli Abruzzi, Italy) and the reference AD method, using a collection of multidrug-resistant (MDR) Enterobacterales and Pseudomonas aeruginosa clinical isolates. METHODS: The collection included 119 carbapenemase-producing Enterobacterales, 53 Enterobacterales producing acquired AmpC-type and/or extended-spectrum ß-lactamases and 38 carbapenemase-producing P. aeruginosa, including representatives of different high-risk clones. AD Fosfomycin and AD reference method (ISO 20776-1:2019) were performed starting from the same microbial suspension. Results were interpreted according to EUCAST clinical breakpoints (10.0). Essential agreement (EA), category agreement (CA) and error rates were calculated as described by the International Organization for Standardization. RESULTS: Of 172 Enterobacterales, 143 (83.1%, including 92.9% (52 of 56) of the NDM-producers and 84.2% (48 of 57) of the KPC-producers) were susceptible to fosfomycin using reference AD. A CA of 91.9% (158 of 172; 95% CI 87.1%-95.3%) and an EA of 92.5% (136 of 147; 95% CI 87.4%-96.0%), respectively, were calculated for the commercial AD Fosfomycin test, with 9.8% (14 of 128) of major errors and no very major errors (0 of 29). Overall, 86.8% (33 of 38) of P. aeruginosa showed a fosfomycin MIC ≤128 mg/L using reference AD. An EA of 84.8% (95% CI 66.3%-92.0%) was calculated for the commercial AD Fosfomycin test, with a CA of 100% (95% CI 93.6%-100%) when considering a tentative breakpoint at 128 mg/L. CONCLUSIONS: AD Fosfomycin showed an overall good concordance compared with reference AD.

Discrepancies in fosfomycin susceptibility testing of KPC-producing Klebsiella pneumoniae with various commercial methods.

Fosfomycin susceptibility testing with Sensititre, Vitek2, Etest, Mic Strip Test and disk diffusion methodologies was compared versus reference agar dilution method (AD) with 78 clinical isolates of KPC-producing Klebsiella pneumoniae. All methodologies showed a Categorical Agreement and Essential Agreement of ≤69% and ≤72%, respectively, revealing a very low concordance with AD.

Treatment responses to antiangiogenetic therapy and chemotherapy in nonsecreting paraganglioma (PGL4) of urinary bladder with SDHB mutation: A case report.

INTRODUCTION: Paraganglioma (PGL) is a rare neuroendocrine tumor. Currently, the malignancy is defined as the presence of metastatic spread at presentation or during follow-up. Several gene mutations are listed in the pathogenesis of PGL, among which succinate dehydrogenase (SDHX), particularly the SDHB isoform, is the main gene involved in malignancy. A 55-year-old male without evidence of catecholamine secretion had surgery for PGL of the urinary bladder. After 1 year, he showed a relapse of disease and demonstrated malignant PGL without evidence of catecholamine secretion with a germline heterozygous mutation of succinate dehydrogenase B (SDHB). After failure of a second surgery for relapse, he started medical treatment with sunitinib daily but discontinued due to serious side effects. Cyclophosphamide, vincristine, and dacarbazine (CVD) chemotherapeutic regimen stopped the disease progression for 7 months. CONCLUSION: Malignant PGL is a very rare tumor, and SDHB mutations must be always considered in molecular diagnosis because they represent a critical event in the progression of the oncological disease. Currently, there are few therapeutic protocols, and it is often difficult, as this case demonstrates, to decide on a treatment option according to a reasoned set of choices.

Multidrug-resistant infections in long-term care facilities: extended-spectrum ß-lactamase-producing Enterobacteriaceae and hypervirulent antibiotic resistant Clostridium difficile.

Infections due to multidrug-resistant (MDR) organisms in long-term care facilities (LTCFs) residents constitute a public health concern. This multicenter study investigated the frequency of ESBL-producing pathogens and MDR Clostridium difficile in clinical specimens from LTCF residents in Italy. During October 2014-March 2015, all urine and diarrheic fecal samples from LTCF residents (≥65 years) with suspected urinary tract infection or C. difficile infection, respectively, received for diagnosis by 4 hospital laboratories located in different cities were analyzed. Antibiotic susceptibility testing, characterization of resistance genes, and molecular typing of pathogens were performed. Of 806 urine cultures collected from 626 residents at 44 different LTCFs, 492 were positive for microbial infection. Of these, 158 were positive for at least an ESBL-producing Enterobacteriaceae species (32.1%), with Escherichia coli as the most frequent ESBL pathogen (23.4%) followed by Klebsiella pneumoniae (4.5%). Furthermore, 4 carbapenemase producers (0.8%) (1 E. coli with VIM-1and 3 K. pneumoniae with KPC-3) were detected. The CTX-M-15 type ESBL predominated in both E. coli (71.3%) and K. pneumoniae (77.3%). Most E. coli isolates (82.6%) belonged to the ST131/H30 clone/subclone. For K. pneumoniae, ST307 and ST15 were frequent (31.8% and 22.7%, respectively), but isolates harboring blaKPC-3 belonged to CC258. Of 136 diarrheic fecal samples collected from 111 residents at 26 different LTCFs, 21 (15.4%) were positive for toxigenic C. difficile; of these, 13 (62%) were MDR (resistant to 3 or more antimicrobial agents of different classes). The predominant C. difficile polymerase chain reaction ribotype was 356/607 (42.9%), followed by 018, 449, and 078 (14% each). Public health efforts are needed to contain the diffusion of CTX-M-producing Enterobacteriaceae and MDR C. difficile in LTCF settings.

Títulos de anticuerpos postvacunales en équidos inmunizados con la cepa tc-83 del virus de la encefalitis equina Venezolana / Post- vaccination antibody titles in equines vaccinated with TC83 strain of the Venezuelan equine encephalitis virus

A raíz de la última epidemia de Encefalitis Equina Venezolana (EEV) ocurrida en Venezuela en 1995, que afectó a équidos y humanos del estado Zulia y otras entidades del país, se implementó el reforzamiento de los programas de vigilancia epidemiológica para la prevención y control de las encefalitis equinas. Se tomó como medida eficaz la implementación de nuevos ciclos de inmunización sistemática de los équidos en las zonas de riesgo. Para evaluar la duración de la inmunidad proporcionada por la vacuna a base de virus atenuado, cepa TC-83, utilizada en el programa de inmunización, se analizaron 662 muestras séricas de équidos vacunados en diferentes períodos (194 con dos años después de vacunados, 412 con un año y 56 con seis meses), sin antecedentes de enfermedad y procedentes de diferentes Municipios del estado Zulia, Venezuela. Las muestras fueron analizadas mediante la técnica de inmunoensayo enzimático (ELISA) para determinar títulos de anticuerpos IgG anti-EEV. Se detectó 39,8% (164/412) de sueros positivos en los animales con un año de vacunación, de los cuales al 60,2% no se les detectaron títulos de anticuerpos. Así mismo, se detectó un 95,9% (186/194) de équidos con dos años de vacunación sin inmunidad anti-EEV. De los 56 équidos con 6 meses de vacunados, 48 (87,7%) mostraron altos títulos de anticuerpos. Los resultados evidencian una pérdida de la inmunidad anti-EEV relacionada con el tiempo post vacunal y una efectiva respuesta en los équidos con seis meses de inmunización, sugiriendo una pronta revisión del programa de vacunación específicamente en cuanto a la evaluación del tiempo de duración de la actividad antigénica y/o posibles fallas en la aplicación de la misma.

As a result of the last Venezuelan equine encephalitis epizoodemic (VEE), happened in Venezuela during 1995 that affected equidae and humans of Zulia State and another states of the country, the reinforcement of epidemiological surveillance programs for the prevention and control of equine encephalitis was stablished. As an efficient measure, the new cycles implementation of systematic equine immunization in the risk areas was taken. In order to evaluate the duration of the immunity with a TC-83 strain attenuated virus vaccine, used in the vaccination program, 662 equidae sera samples, vaccinated at different times (194 with two years, 412 with a year and 56 with 6 months postvaccinated) without disease precedents and from different municipalities of Zulia State, Venezuela, were analyzed through an immune enzymatic assay (ELISA) to determine IgG anti VEE antibodies titles. A 39.8% (164/412) of positive sera in one year postvaccinated animals was detected, from which 60.2% do not showed antibodies titles. Furthemore, a 95.9% (186/194) equidae with two years postvaccinated without immunity to anti-VEE were detected. From the 56 equidae with 6 months postvaccinated, 48 (87.7%) showed high antibodies titles. The results demonstrated a lack of anti-VEE immunity, suggesting a prompt revision of the vaccination program specifically related to the evaluation of the antigenic’s activity length time and/or possible faults in its application.