RESUMEN
Echinococcosis/hydatidosis is a parasitic zoonosis caused in humans by the larval stage of the Echinococcus granulosus cestode. Although notification of infestation is required, there are no reliable data on the prevalence of this parasitosis among humans in Italy. This zoonosis was first reported in ancient times (Hippocrates, fourth century BC) and since then many cases of echinococcosis/hydatidosis have been described. Currently, it is considered one of the main parasitoses affecting animals bred for income and one of the most important parasitic zoonoses. We present the clinical case of a three-year-old child, living in Palermo with a dog in his house, who came to our observation for dyspnea occurring after physical exercise. Diagnosis of echinococcosis was performed on the operating table and by histological examination. The case presented is special in its manifestation from a clinical point of view, because the young patient experienced multiple injuries only to lungs, without involvement of other organs and, although the left lung cysts appeared fissured on the operating table, our patient never presented immunoallergic disorders.
Asunto(s)
Equinococosis Pulmonar/diagnóstico , Albendazol/uso terapéutico , Animales , Antihelmínticos/uso terapéutico , Preescolar , Vectores de Enfermedades , Perros/parasitología , Disnea/etiología , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/tratamiento farmacológico , Equinococosis Pulmonar/cirugía , Equinococosis Pulmonar/transmisión , Humanos , Masculino , Neumonectomía/métodos , Tomografía Computarizada por Rayos XRESUMEN
In a retrospective study of cases of infective endocarditis (IE) observed in adult patients, the data of patients hospitalized for definite IE in the Cardiosurgery Unit of ARNAS-Civico in Palermo (Italy) from March 2003 to September 2006 were analysed. All cases were classified according to the modified Duke criteria. In all, 36 immunocompetent patients with "definite" IE were included (20 males and 16 females with a median age of 54 years). The aortic valve (23/36, 64%) was the most commonly involved, followed by the mitral (19/36, 52.7%) and tricuspid valve (4/36, 11%). In 10 patients (27.7%), a double localization was observed. Blood culture yielded a positive result in 15 cases. Staphylococci and enterococci were the pathogens most commonly identified. Valvular diseases and previous cardiosurgical procedures were the risk factors most commonly noted. Four patients developed complications during the course of the disease, one of whom died. In patients with positive blood culture, antibiotics were prescribed on the basis of susceptibility test results. In patients with negative blood culture, empiric therapy was directed against Gram+ bacteria (glycopeptides, aminoglycosides and betalactams). Surgical therapy was necessary in 25 patients (69.4%). The patients were subsequently enrolled in a cardiological and infectivological follow-up. Our results showed that rapid diagnosis, correct antibiotic therapy and early surgical treatment improve the outcome in patients with infective endocarditis.
Asunto(s)
Endocarditis Bacteriana/epidemiología , Adulto , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Candidiasis/epidemiología , Terapia Combinada , Endocarditis/epidemiología , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Femenino , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Inmunocompetencia , Italia/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
The purpose of this study was to evaluate whether the risk of transfusion-transmitted visceral leishmaniasis was present in an area of western Sicily where the incidence of the disease is higher than the regional average. From May to December 2005, 1449 blood donors from Agrigento district (Sicily, Italy) were screened for the presence of anti-Leishmania antibodies by an indirect immunofluorescent antibody test (IFAT). Blood samples from IFAT-positive donors were examined by PCR to detect Leishmania DNA. Anti-Leishmania antibodies were found in 11 (0.75%) cases, among which Leishmania DNA was detected from four (36.4%). Particular techniques to inactivate different pathogens would be considered mandatory in the case of immunosuppressed recipients.
Asunto(s)
Donantes de Sangre , Portador Sano/epidemiología , Leishmania infantum/aislamiento & purificación , Leishmaniasis Visceral/epidemiología , Leishmaniasis Visceral/transmisión , Adulto , Animales , Anticuerpos Antiprotozoarios/sangre , ADN Protozoario/sangre , Femenino , Humanos , Italia/epidemiología , Leishmania infantum/genética , Leishmania infantum/inmunología , Masculino , Persona de Mediana EdadRESUMEN
Ascaridiasis is a geohelminthiasis with a worldwide distribution, especially occurring in countries with hot-humid climates. The infection occurs most frequently in children between three and nine years of age. We report a case of ascaridiasis regarding a ten-year-old girl born in Bangladesh who arrived in Italy about one year before. During laparotomy for suspected acute appendicitis, a large number of ascaridia nematodes were seen in the small intestine.
Asunto(s)
Abdomen Agudo/parasitología , Ascaridiasis/complicaciones , Niño , Femenino , HumanosRESUMEN
Visceral leishmaniasis (VL) is endemic in Sicily (48 new cases in 2004, of which nine were in Agrigento). In southern Europe between 25-70 per cent of adult VL cases are related to HIV infection. The HIV cases have a high risk (1.5-9%) of developing VL either as a new infection or as the revival of a latent infection. We therefore carried out serologic screening to detect antibodies against L. infantum by IFAT in 1449 blood donors in Agrigento and the surrounding area (May-December 2005) and in 120 HIV+ in western Sicily, all of whom were asymptomatic and had no history of VL. L. DNA was assessed by nested PCR in blood samples of some seropositive donors. Of the 1449 blood donors, 11 (0.75%) were positive by IFAT and three of them were also positive in PCR. L. infantum seropositivity is most probably the expression of recent infection because the clearance of serum antibodies is rather fast (6-12 months) after VL. This is why blood donation by Leishmania seropositive donors, whether positive or negative by PCR, could constitute an infection risk especially for immunosuppressed recipients, who should receive deleukocyted blood. Moreover it could be useful to monitor HIV/Leishmania coinfection cases to avoid the risk of slatentization of L. infection when CD4+ levels are very low.
Asunto(s)
Anticuerpos Antiprotozoarios/sangre , Donantes de Sangre , Enfermedades Endémicas , Seropositividad para VIH/sangre , Leishmania infantum/inmunología , Leishmaniasis Visceral/sangre , Leishmaniasis Visceral/diagnóstico , Adolescente , Adulto , Anciano , Animales , Femenino , Seropositividad para VIH/parasitología , Humanos , Leishmaniasis Visceral/epidemiología , Masculino , Persona de Mediana Edad , Pruebas SerológicasRESUMEN
Spondylodiscitis is an infection of the intervertebral disk and the adjacent vertebrae, with or without associated epidural or psoas abscesses. It is a serious disease both due to its long-term course and the possible outcomes. It is frequently caused by S. aureus and, in endemic areas, by Mycobacterium tuberculosis and Brucella spp. We describe 9 cases, from October 2004 to August 2005, all spontaneous diseases occurring in adults (mean age 64 years). The site of infection was lumbar in 7, lumbar-sacral in 1 and dorsal in 1. None were associated to sepsis. The causative bacteria were known in 6 cases (1 BK, 1 S. aureus, 4 Brucella) and unknown in 3 cases. In all cases therapy was only medical. Significant circulation in Sicily of both Mycobacterium tuberculosis and Brucella spp. make those microorganisms the most frequent agents of spondylodiscitis.
Asunto(s)
Discitis , Adulto , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Brucella/aislamiento & purificación , Brucelosis/complicaciones , Discitis/diagnóstico , Discitis/tratamiento farmacológico , Discitis/etiología , Discitis/microbiología , Femenino , Humanos , Vértebras Lumbares , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Infecciones Estafilocócicas/complicaciones , Staphylococcus aureus/aislamiento & purificación , Vértebras Torácicas , Factores de Tiempo , Tuberculosis de la Columna Vertebral/complicacionesRESUMEN
Mycetoma (or "madura foot") is characterized by deformation, cutaneous lesions, infection of tissues extending from the cutaneous layer to the underlying fascia, and an indolent course. A number of fungal or bacterial agents that are introduced through traumatic inoculation can be responsible for the disease, but Actinomadura madurae is among the most common agents of mycetoma occurring worldwide. We report a case of madura foot caused by A. madurae in an immunocompetent young Somali man who was admitted with a diagnosis of skin and soft tissue infection of the left foot with osteomyelitis. The present report emphasizes the importance of the knowledge of this infection, which is sporadic but problematic to treat and, above all, difficult to diagnose. Moreover, a multidisciplinary approach with involvement of an infectious diseases specialist with experience in tropical diseases and a microbiology unit performing rapid molecular diagnostic tests is required for early diagnosis and an optimal antibiotic therapy.
Asunto(s)
Enfermedades Transmisibles Importadas , Micetoma , Enfermedades Transmisibles Importadas/diagnóstico , Enfermedades Transmisibles Importadas/tratamiento farmacológico , Humanos , Italia , Masculino , Micetoma/diagnóstico , Micetoma/tratamiento farmacológico , Somalia/etnología , Adulto JovenAsunto(s)
Bacteriemia/microbiología , Fiebre Botonosa/microbiología , Rickettsia conorii/genética , Bacteriemia/diagnóstico , Proteínas Bacterianas/genética , Fiebre Botonosa/diagnóstico , Humanos , Tipificación de Secuencias Multilocus , Rickettsia conorii/aislamiento & purificación , Homología de Secuencia de Ácido Nucleico , SiciliaRESUMEN
The aim of our study was to evaluate the role of Salmonella spp in children hospitalised for acute gastroenteritis, and to study clinical and microbiological features of paediatric salmonellosis in our geographical area. In all, 540 patients admitted from March to September 2003 with symptoms of acute enteritis to the Infectious Diseases department of the "G. Di Cristina" hospital in Palermo were enrolled. Stool samples were collected within 48 hours of admission and tested for intestinal pathogens (bacterial, viral, parasites). Salmonella spp was detected in 18.5% of samples. The median age of infected children was 4.5 years. Salmonella enteritidis (49%) and Salmonella typhimurium (37%) were the most commonly identified genotypes. S. enteritidis infection was more frequently characterized by vomiting (65.3%) and dehydration (61.2%). Bloody diarrhoea was more common in S. typhimurium infection (40.5%). All strains were susceptible to ceftriaxone, while 40% of strains were resistant to tetracyclines and 37% to ampicillin.
Asunto(s)
Gastroenteritis/epidemiología , Infecciones por Salmonella/epidemiología , Salmonella/aislamiento & purificación , Infecciones por Adenoviridae/epidemiología , Adolescente , Infecciones por Campylobacter/epidemiología , Niño , Preescolar , Comorbilidad , Deshidratación/etiología , Resistencia a Medicamentos , Disentería Bacilar/epidemiología , Femenino , Fiebre/etiología , Gastroenteritis/complicaciones , Gastroenteritis/microbiología , Gastroenteritis/virología , Hospitalización , Humanos , Lactante , Recién Nacido , Parasitosis Intestinales/epidemiología , Italia/epidemiología , Masculino , Estudios Retrospectivos , Infecciones por Rotavirus/epidemiología , Salmonella/clasificación , Salmonella/efectos de los fármacos , Intoxicación Alimentaria por Salmonella/epidemiología , Intoxicación Alimentaria por Salmonella/microbiología , Infecciones por Salmonella/complicaciones , Infecciones por Salmonella/microbiología , Especificidad de la EspecieRESUMEN
Strongyloidiasis is caused by a small intestinal nematode with a complex life cycle. In Italy the infection is endemic in rural areas of the Po Valley. The clinical syndrome of S. stercoralis encompasses a broad spectrum of symptoms and signs and, in the immunocompromised host, larvae can migrate to different organs and tissues. Also immune response seems to play a role in the pathogenesis of the disease. We report a case of strongyloidiasis complicated by Gram-negative sepsis and nephrotic syndrome in an immigrant from South America with a normal immune response. Whereas sepsis cleared up quickly, parasitic clearance was obtained only after treatment with ivermectin and nephrotic syndrome was still present three months after the end of treatment.
Asunto(s)
Bacteriemia/complicaciones , Infecciones por Escherichia coli/complicaciones , Síndrome Nefrótico/etiología , Estrongiloidiasis/complicaciones , Adulto , Albendazol/uso terapéutico , Animales , Antihelmínticos/uso terapéutico , Antibacterianos/uso terapéutico , Ecuador/etnología , Enfermedades Endémicas , Infecciones por Escherichia coli/tratamiento farmacológico , Humanos , Inmunocompetencia , Italia/epidemiología , Ivermectina/uso terapéutico , Larva , Masculino , Nefrosis Lipoidea/etiología , Prednisona/uso terapéutico , Strongyloides stercoralis/crecimiento & desarrollo , Estrongiloidiasis/tratamiento farmacológico , Estrongiloidiasis/epidemiología , Estrongiloidiasis/inmunología , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Actinomycosis is a bacterial infection due to Gram-positive bacteria of the Actinomyces genus. The authors describe two cases: one of them occurred in a woman with a clinical presentation of a right submandibular indurative mass. After surgery, histological examination showed a granulomatous tissue with many actinomycetes. The second case was observed in a man admitted to hospital with a diagnosis of pulmonary heteroplastic lesion. Also in this case, histological examination showed many actinomycotic colonies. Actinomycosis is an uncommon disease. Establishment of definite diagnosis requires a high index of suspicion in all cases of relapsing cervical lesions. Pulmonary actinomycosis is a rare diagnosis; respiratory physicians should be aware of this important differential when investigating patients for persistent pulmonary shadowing.
Asunto(s)
Actinomicosis , Actinomicosis/diagnóstico , Actinomicosis/terapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Eosinophils were previously considered granulocytes involved in host protection against helminth infections and in inflammation related to atopic diseases. Instead, as supported by recent studies, eosinophils are today considered multifunctional cells involved also in homeostasis of the gastrointestinal tract and other organs, conferring innate and adaptive immunity to certain bacteria and viruses, and perhaps in the control of oncogenicity. Unexplained eosinophilia could be an expression of paraneoplastic syndrome or constitutional factors. Irrespective of the underlying conditions and aetiology of eosinophilia, eosinophil-derived substances may induce potentially irreversible organ damage. A diagnostic algorithm is discussed.
Asunto(s)
Eosinofilia/inmunología , Eosinófilos/inmunología , Síndromes Paraneoplásicos/inmunología , Inmunidad Adaptativa/inmunología , Dermatitis Atópica/inmunología , Eosinofilia/sangre , Eosinofilia/diagnóstico , Eosinófilos/citología , Tracto Gastrointestinal/inmunología , Helmintiasis/inmunología , Homeostasis/inmunología , Humanos , Inmunidad Innata/inmunología , Síndromes Paraneoplásicos/diagnósticoRESUMEN
BACKGROUND: The flogosis markers currently in use show both low sensitivity and specificity, particularly in neoplastic and degenerative diseases. Procalcitonin (PCT) is a pro-peptide of calcitonin produced mainly but not only in the C-cells of the thyroid glands and, as several studies show, PCT levels in plasma increase during infections. Bacterial infections are also the main cause of death in oncological patients. Furthermore, in patients with leukaemia in chemotherapy recovery, infections often induce relapses. The aim of the present study is to detect PCT levels in plasma in oncohaematologic patients with and without infections. METHODS: The study was carried out on 54 patients by a quantitative automated immunoassay. RESULTS: PCT plasma levels > or =0.5 ng were detected in 27 out of 30 patients (90,0%) with bacterial infections; 8 out of 9 patients (88,9%) with viral infections and in 12 out of 15 patients in the control group without statistically significant differences. CONCLUSIONS: The results, which differ from those in the literature, are discussed.
Asunto(s)
Infecciones Bacterianas/sangre , Infecciones Bacterianas/complicaciones , Calcitonina/sangre , Leucemia/sangre , Leucemia/complicaciones , Linfoma/sangre , Linfoma/complicaciones , Precursores de Proteínas/sangre , Infecciones Bacterianas/diagnóstico , Péptido Relacionado con Gen de Calcitonina , Niño , Preescolar , Humanos , Inmunoensayo , Virosis/sangre , Virosis/complicaciones , Virosis/diagnósticoRESUMEN
Visceral leishmaniasis (VL) is endemic in areas bordering the Mediterranean Sea (Spain, Italy, France, Greece, Morocco, Tunisia) where it is caused by Leishmania infantum and is transmitted by the bite of a hematophagous sandfly belonging to Phlebotomus spp.; the dog constitutes the main reservoir of infection. Two cases of VL in immunocompetent children are described. Both patients lived in endemic areas for leishmaniasis (Sicily) and at admission were febrile, pale and had splenomegaly. In both patients anti-leishmania antibodies were present and a definitive diagnosis was confirmed by demonstration of leishmania parasites by microscopy or polymerase chain reaction (PCR) in the bone marrow aspirates. The use of PCR performed on peripheral blood has been reported to be highly sensitive for the diagnosis and follow-up of children with VL. One patient was treated with N-dimethylglucamine, Glucantim, the other one with liposomal Amphotericin B (AmBisome). Both had symptomatic relapses 3 months later, and recovered following re-treatment with AmBisome administered intravenously at a dosage of 3 mg/Kg for ten consecutive days. The patients were monitored for one year after treatment was completed.
Asunto(s)
Anfotericina B/uso terapéutico , Antiprotozoarios/uso terapéutico , Leishmaniasis Visceral/tratamiento farmacológico , Meglumina/uso terapéutico , Compuestos Organometálicos/uso terapéutico , Anfotericina B/administración & dosificación , Médula Ósea/parasitología , Femenino , Humanos , Inmunocompetencia , Lactante , Leishmaniasis Visceral/inmunología , Liposomas/administración & dosificación , Masculino , Antimoniato de Meglumina , Parasitemia/tratamiento farmacológico , Parasitemia/inmunología , RecurrenciaRESUMEN
INTRODUCTION: Campylobacter spp is the main cause of bacterial gastroenteritis in the developed countries, resulting mainly from the contamination of poultry and animal products. Pathogenesis remains unclear. Various clinical features ranging from watery diarrhoea in apyrexia to dysentery in hyperpyrexia may be the result of differences between strains in the expression of different pathogenetic factors. There are many difficulties in isolating the bacteria in question. METHODS: We processed 540 faecal specimens of children with gastroenteritis. We detected enteropathogen bacteria including Campylobacter spp as well as Rotavirus, Adenovirus and protozoans. For the isolation of Campylobacter we employed the filter membrane technique. The filtrate was plated onto non-selective agar (blood-agar) in microaerophilic atmosphere. RESULTS: The rank order of isolation frequency was: Rotavirus (30.0%), Salmonella (18.5%), Adenovirus (12.6%), Campylobacter (6.5%), Shigella (1.1%), Giardia (0.6%). The Campylobacter strains belonged to C.jejuni in 31 cases and C. coli in 4 cases. The clinical features were: fever (80%), vomitus (31,4%) and diarrhoea in all cases (watery diarrhoea (25.7%), stools more compact with mucus and blood (57.1%) or with mucus alone (17.1%)). CONCLUSIONS: In Western Sicily Campylobacter spp is the second most common agent of bacterial enteritis. We believe that some procedural errors, such as the employment of excessively selective media, could be the cause of the past failure to isolate Campylobacter.
Asunto(s)
Infecciones por Campylobacter/microbiología , Campylobacter/aislamiento & purificación , Enteritis/microbiología , Niño , Preescolar , Humanos , Lactante , ItaliaRESUMEN
HHV8 has been consistently linked to both classical and endemic Kaposi's Sarcoma (KS), primary effusion lymphoma and multicentric Castleman's disease. HHV8 has also been associated to other oncologic diseases although such reports have not been confirmed. Little is known about the transmission routes of HHV8. The main transmission route may differ between developed and developing countries. We carried out a serologic study by Immunofluorescence of antiHHV8 antibodies on 40 children with Acute Lymphoblastic Leukaemia (ALL) and their relatives. 5 children with ALL were positive (12.5%). Seroprevalence was not significantly higher than the western Sicily pediatric population. The variation in seroprevalence between the relatives of HHV8 seropositive and seronegative patients was not significant. Therefore HHV8 does not appear to be correlated with ALL and the main transmission route in our cases could occurr outside the family.
Asunto(s)
Herpesvirus Humano 8 , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Sarcoma de Kaposi/complicaciones , Adolescente , Anticuerpos Antivirales/sangre , Niño , Preescolar , Femenino , Herpesvirus Humano 8/inmunología , Humanos , Masculino , Sarcoma de Kaposi/sangreRESUMEN
Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Dermatomicosis/diagnóstico , Seropositividad para VIH/complicaciones , Histoplasma , Histoplasmosis/diagnóstico , Huésped Inmunocomprometido , Piel/microbiología , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Terapia Antirretroviral Altamente Activa , Dermatomicosis/microbiología , Diagnóstico Diferencial , Quimioterapia Combinada , Ghana , Histoplasma/aislamiento & purificación , Histoplasmosis/tratamiento farmacológico , Humanos , Italia , Itraconazol/uso terapéutico , Lepra/diagnóstico , Masculino , Piel/patología , Resultado del TratamientoRESUMEN
Brucellosis is a common zoonosis, endemic in Mediterranean countries, and caused by bacteria of Brucella genus. Brucellosis is a systemic infection and the clinical presentation varies widely from asymptomatic and mild to severe disease. Cardiovascular complications are extremely rare. We present a case of arterial thrombosis in a previously healthy young patient with Brucella endocarditis. Careful attention must be paid to any sign or symptom of thrombosis in patients affected by brucellosis, regardless of the presence of endocarditis and cardiovascular risk factors.