[Measles, mumps, rubella and varicella: antibody titration and vaccinations in a large hospital]. / Morbillo, parotite, rosolia e varicella: titolazione anticorpale e vaccinazioni in un ospedale di grandi dimensioni.

The occurrence contagious diseases such as measles, varicella, mumps and rubella in the hospital open creates situations of alarm, due to the potential involvement of workers, but most importantly for the oftentimes harmful consequences for critical patients, such as pregnant women or immunocompromised individuals. In 2007 antibody titration was initiated in our hospital for four infectious diseases, also pursuant to the Lombardy Region Resolution N. VIII/1587 of 22-12-2005 "Decisions regarding vaccinations in children and adults in the Lombardy Region" which indicate the departments in which a priority exists: maternity-neonatal and infectious illnesses. In 2011 a vaccination campaign was launched for unprotected operators in the Health and Medical Management departments: after an interview with the competent physician of reference, the subjects voluntary submitted themselves to vaccination. The protective antibody data encountered over the years are similar to that reported in the literature, with coverage percentages greater than 93% for varicella and rubella, over 89% for measles and over 85% for mumps. Approximately 80% of the operators are protected against all four diseases. However, the dramatic consequences of potential contagion lead us to strongly recommend vaccinations for non-protected subjects. At present 37 operators have been vaccinated with the trivalent MMR vaccine (Measles, Mumps and Rubella) and 14 for Varicella. The antibody response was verified in all cases.

Phenotyping of Cryptococcus neoformans strains in Bergamo, Italy (1985-2000).

Cryptococcus neoformans is the cause of the most common life-threatening fungal infection in patients with AIDS. Thirty strains of C. neoformans were collected from inpatients and typied evaluating activity, morphotyping, serotyping, chemosensitivity and adhesivity. Cryptococcus neoformans strains showed different aspectotype profile, the sole presence of serotypes A and D, good susceptibility to azoles and Amphotericin B. Phenotypic epidemiologic markers can be used: characterization of clinical strains excludes a common source.

Urinary detection of Streptococcus pneumoniae antigen for diagnosis of pneumonia.

Streptococcus pneumoniae is one of most common causes of community-acquired pneumonia. We evaluated a newly available rapid immunochromatographic test to detect S. pneumoniae in urine samples verifying its importance in the diagnosis of pneumococcal pneumonia. Our data, obtained from 104 patients with community-acquired pneumonia, show that Now S. pneumoniae Urinary Test is characterized by a sensitivity value of 77.7%, a specifity of 98.8%: positive and negative predictive values are 93.3% and 95.5%, respectively. In conclusion, Now S. pneumoniae Urinary Test should be a useful test to establish the etiology of community-acquired pneumonia.

Lactobacillus casei subsp. rhamnosus sepsis in a patient with ulcerative colitis.

Lactobacillus species are part of normal gastrointestinal flora and are an uncommon cause of bacteremia. Lactobacillus casei subsp. rhamnosus was repeatedly isolated in the blood cultures of a 43-year-old woman with ulcerative colitis. Lactobacillus spp. could be considered a potential opportunistic pathogen whenever there is disruption of the physiologic architecture of the intestinal mucosa, such as in abdominal surgery, endoscopic procedures, or enteric pathologies. Clinicians and clinical microbiologists need to be aware of this infective complication in patients with ulcerative colitis.

Pneumonia due to Leptospira spp.: results of an epidemiological and clinical study.

OBJECTIVE: To evaluate the prevalence of Leptospira spp. infections in a population of in- and out-patients with community acquired pneumonia (CAP) and the incidence of leptospiral pneumonia. DESIGN AND RESULTS: Of 176 patients infected with CAP who were evaluated for the presence of Leptospira spp. as causative agent, 10 were found positive for leptospiral antibodies (prevalence rate: 5.7%), but seroconversion was observed in only one case (incidence rate: 0.6%). The patient had had recent contact with possibly contaminated water. She had pulmonary involvement and signs of mild hepatic damage, but recovered fully. CONCLUSION: The authors highlight the importance of testing for leptospirosis in case of pneumonia in endemic areas where the more common causative pathogens for CAP can not be documented and when initial empiric therapy is ineffective.

Unusual case of pulmonary rickettsiosis in non-Hodgkin's lymphoma.

A case report of boutonneuse fever with pulmonary complications in a patient with non-Hodgkin's lymphoma (NHL) is described. The patient was hospitalized for persistent hypertermia and marked dyspnea, with radiographic findings of bilateral involvement of the lungs. The confirmation of the diagnosis was obtained by means of serum analyses (Weil-Felix serodiagnosis and IFA); the patient responded to doxycycline with progressive improvement of her general health condition. In this case the occurrence of a NHL could justify the lower reactivity and the facilitated diffusion of rickettsiosis in the patient.

Early ganciclovir therapy effectively controls viremia and avoids the need for cytomegalovirus (CMV) prophylaxis in renal transplant patients with cytomegalovirus antigenemia.

Cytomegalovirus (CMV) infection is still a problem for organ transplant recipients despite studies that long-term prophylaxis with high dose of acyclovir or ganciclovir given to all organ recipients may limit the consequences of infection and disease. In the present report of 160 consecutive renal transplant patients, we used a diagnostic assay for CMV antigenemia (detection of CMV antigen in peripheral blood leukocytes) and treated with ganciclovir only those patients who had a positive test. No patient in this series had routine prophylaxis. Out of 160 patients, 71 had clinical and/or laboratory signs of infection, and were tested for early antigen in peripheral leukocytes. The test was positive in 35, all of whom received a course of 3 wk ganciclovir treatment which effectively cured CMV in 34 count of 35. One patient was ganciclovir-resistant, but responded to foscarnet. None of the 36 patients who had no early antigenemia and did not receive treatment developed the disease. The treatment was extremely well tolerated in all our patients with no adverse events. Thus, even though this was not a controlled study, our present results may be taken to indicate that long-term acyclovir or ganciclovir for all organ transplant recipients might be no longer totally justified. We conclude that detecting viral antigen in circulating leukocytes identifies patients who are indeed at risk of developing severe CMV disease. When these patients are treated early enough, CMV is eliminated with a relatively short course of ganciclovir, which has virtually no side effects.

Community-acquired pneumonia: is there difference in etiology between hospitalized and out-patients?

Since March 1991 a prospective 1-year study of patients with community-acquired, radiologically verified, pneumonia (CAP) was performed at the Divisione Pneumologica, Ospedali Riuniti Bergamo, and at the Centro Pneumo-Allergologico, Bergamo, Italy. The study included 119 out-patients and 60 in-patients, with a median age of 37.4 and 49.8 years respectively. There were not statistically significant differences between the patients included with respect to the various months. The most common underlying illnesses were: chronic obstructive pulmonary disease (20.7%), diabetes (7.3%) and malignancy (3.4%). We found a quite different etiology of CAP between out- and in-patients. By far the most common etiologic agent in out-patients was Mycoplasma pneumoniae (32.8%), while in in-patients was Legionella pneumophila (11.7%). 5 patients had a double infection. There were no distinctive clinical and radiological features found to be diagnostic for any etiologic agent. Hospital stay averaged 12.1 days. 35% of the patients included in the study were been treated by beta-lactam, often parenterally, nevertheless 88 pathogens of the 100 identified were resistant to this antimicrobial therapy. We believe that there should always be a macrolide, erythromycin or the latest ones such as azythromycin, in the treatment of CAP, owing to their efficiency, ease of use and lower cost.

Epidemiological characteristics of Pseudomonas aeruginosa strains causing infection in an Italian general hospital. A one-year surveillance.

During the 1989 calendar year, P. aeruginosa caused clinical infections in 0.46% of patients admitted to Ospedali Riuniti (a general hospital), Bergamo, Italy. Strains (n = 267) of P. aeruginosa were collected during this period, and epidemiological characteristics were studied. The mean prevalence of P. aeruginosa infection in inpatients was 1.1% (range 0.06-7.3), whereas outpatients showed a significantly lower prevalence of infection (0.05%). Strains were recovered from inpatients of surgical wards (n = 126; 47.2%), and outpatients (n = 15; 5.6%). Males were more often affected than females (2.7:1). Infection of the urinary tract was the most common (34.1%). Pseudomonas aeruginosa was also involved in lower respiratory tract infections (18.7%) and septicaemia (17.6%). Four typing methods were performed, i.e. serotyping, antibiotyping, pyocin typing, and restriction endonuclease analysis (REA). Serotypes O:11 and O:6 were endemic in the hospital. Some serotypes correlated with specific clinical wards. Pyocin typing was an unreliable epidemiological tool. However, antibiotyping showed the presence of some epidemic clusters, probably related to the antibiotic consumption of the patients. REA suggested the circulation of edemic P. aeruginosa strains in both the obstetrics and neurosurgery wards.

[Tuberculosis in Bergamo Province. Statistical estimates for the quadrennium 1984-1987]. / La tubercolosi nella provincia di Bergamo. Alcune valutazioni sul quadriennio 1984-1987.

The clinical files of patients admitted to the Ospedali Riuniti of Bergamo between January 1984 and December 1987 in which the presence of mycobacteria has been demonstrated have been reviewed. We have analysed the clinical pattern and the complicating diseases and we have reported the typing of mycobacteria in comparison with the literature data. We stress the danger of mycobacterial infections particularly in patients who are in an immunodepressed state.

Clinical evaluation of non-radiometric BACTEC NR 660 system for routine detection of bacteremia.

A study was undertaken to evaluate the sensitivity, accuracy and practicability to a two-bottle nonradiometric blood culture system (BACTEC NR 660) with the two bottle conventional blood culture system in use in our laboratory. A total of 592 sets of four blood culture bottles were collected from adults in a twenty-week period, giving 126 positive sets. The conventional system recovered 121 isolates, whereas the BACTEC NR 660 system recovered 97 microorganism. The difference in the recovery rate was not statistically significant. Contaminant isolates were detected with greater frequency in the conventional system (p less than 0.001). Microorganism were recovered faster in one or both BACTEC NR 660 bottles than in conventional system (p less than 0.001). Our study confirms that BACTEC NR 660 system is suitable for routine detection of bacteremia.