RESUMO
BACKGROUND: SARS-CoV-2 pandemic has posed formidable public health and clinical challenges. The use of immunosuppressive agents, such as high dose corticosteroids and cytokine inhibitors (e.g., Tocilizumab) has been suggested to contrast the hyperinflammatory process involved in the pathogenesis of the severe disease, with conflicting evidence. Among the drawbacks of immunosuppressive therapy, the risk of reactivation of latent infections, including parasitic infestations, is to be considered. CASE PRESENTATION: We report a case of a 59-year-old Italian patient treated with high dose intravenous dexamethasone and two intravenous doses of Tocilizumab for interstitial bilateral pneumonia associated with SARS-CoV-2 infection who developed itching, abdominal pain, and an increased eosinophil count. Stool examination confirmed the presence of S. stercoralis larvae. The patient was treated with a 4-day course of Ivermectin with full recovery. DISCUSSION: We report the first case of S. stercoralis infection following an 11-day treatment with high-dose steroids and Tocilizumab for severe COVID-19. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19.
Assuntos
Tratamento Farmacológico da COVID-19 , Imunossupressores/efeitos adversos , Infecção Latente/etiologia , Estrongiloidíase/etiologia , Animais , Anticorpos Monoclonais Humanizados/efeitos adversos , Antiparasitários/uso terapêutico , COVID-19/complicações , Dexametasona/efeitos adversos , Fezes/parasitologia , Feminino , Humanos , Ivermectina/uso terapêutico , Infecção Latente/diagnóstico , Infecção Latente/tratamento farmacológico , Pessoa de Meia-Idade , SARS-CoV-2 , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Resultado do TratamentoRESUMO
We report miscarriage following dengue virus (DENV)-3 infection in a pregnant woman returning from Bali to Italy in April 2016. On her arrival, the woman had fever, rash, asthenia and headache. DENV RNA was detected in plasma and urine samples collected the following day. Six days after symptom onset, she had a miscarriage. DENV RNA was detected in fetal material, but in utero fetal infection cannot be demonstrated due to possible contamination by maternal blood.
Assuntos
Aborto Espontâneo/virologia , Anticorpos Antivirais/sangue , Vírus da Dengue/isolamento & purificação , Dengue/diagnóstico , Complicações Infecciosas na Gravidez/virologia , RNA Viral/genética , Astenia/virologia , Dengue/sangue , Dengue/complicações , Dengue/virologia , Vírus da Dengue/classificação , Vírus da Dengue/genética , Vírus da Dengue/imunologia , Ensaio de Imunoadsorção Enzimática , Exantema/virologia , Feminino , Febre/etiologia , Febre/virologia , Cefaleia/virologia , Humanos , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Indonésia , Transmissão Vertical de Doenças Infecciosas , Itália , Gravidez , Resultado da Gravidez , Primeiro Trimestre da Gravidez , Análise de Sequência de DNA , ViagemRESUMO
X-linked agammaglobulinemia (XLA) is a primary immunodeficiency characterized by marked reduction in serum immunoglobulins and early-onset infections. Coronavirus Disease-2019 (COVID-19) pneumonia in immunocompromised patients presents clinical and radiological peculiarities which have not yet been completely understood. Very few cases of agammaglobulinemic patients with COVID-19 have been reported since the beginning of the pandemic in February 2020. We report two cases of migrant COVID-19 pneumonia in XLA patients.
Assuntos
Agamaglobulinemia , COVID-19 , Doenças Genéticas Ligadas ao Cromossomo X , Pneumonia , Humanos , COVID-19/complicações , Agamaglobulinemia/complicações , Agamaglobulinemia/diagnóstico por imagemRESUMO
During the SARS-CoV-2 pandemic, the province of Brescia (Italy) had a significant number of COVID-19 cases, which led to a subversion of the ordinary structure of the university hospital ASST Spedali Civili, driven by the need to hospitalize as many patients as possible in a narrow period of time. At the peak of the epidemic, a rapid hospitalization discharge area, the Discharge Ward (DW), was set up with the aim of facilitating the rapid turnover of patients in the wards where the most severe patients had to be hospitalized. The organization and activities carried out are described in the results of this reproducible experience during epidemic events.
Assuntos
COVID-19/epidemiologia , Pandemias , Alta do Paciente , SARS-CoV-2 , Recursos Humanos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ocupação de Leitos/estatística & dados numéricos , COVID-19/mortalidade , Comorbidade , Feminino , Unidades Hospitalares/organização & administração , Humanos , Itália/epidemiologia , Tempo de Internação , Masculino , Corpo Clínico Hospitalar/organização & administração , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Recursos Humanos de Enfermagem Hospitalar/estatística & dados numéricos , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
To determine HIV prevalence and place of exposure for illegal migrants in Italy, we tested 3,003 illegal adult migrants for HIV; 29 (0.97%) were HIV positive. Antibody avidity index results (indicators of time of infection) were available for 27 of those persons and showed that 6 (22.2%) presumably acquired their infection after migration.
Assuntos
Infecções por HIV/epidemiologia , Migrantes , Adolescente , Adulto , África Subsaariana/etnologia , Idoso , Feminino , Soropositividade para HIV/epidemiologia , HIV-1 , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Assunção de Riscos , Trabalho Sexual , Sexo sem Proteção , Adulto JovemRESUMO
We evaluated the association between human papillomavirus cervical infection and HIV shedding in cervicovaginal lavage fluid (CVL), studying 89 HIV-infected women recruited at the Department of Infectious Diseases of Brescia (Italy). HIV shedding in CVL was found in a similar proportion of women with (30%; 21/70) and without (31.6%; 6/19) cervical human papillomavirus infection. A statistically significant correlation was found between HIV viral load in serum and CVL among the 27 women with detectable HIV in CVL (r = 0.4; P = 0.04). However, women on highly active antiretroviral therapy were more likely to have detectable HIV-RNA in CVL despite negative viremia (80% vs. 8%; P < 0.005).
Assuntos
Líquidos Corporais/virologia , Infecções por HIV/complicações , Infecções por HIV/virologia , HIV/isolamento & purificação , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/virologia , Eliminação de Partículas Virais , Adulto , Antirretrovirais/uso terapêutico , Sangue/virologia , Colo do Útero/virologia , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Itália , Pessoa de Meia-Idade , Vagina/virologia , Carga Viral , Adulto JovemRESUMO
During 2009 there was an increased incidence of acute hepatitis A virus (HAV) infection among homosexual males which, in our institute, outnumbered the number of cases in travellers, thus becoming the prime HAV risk factor. Some of our HAV cases occurred in HIV-infected subjects. This observation underlines the action of HAV as a sexually transmitted infection and urges preventive measures, such as routine HAV vaccination in the HIV-infected population.
Assuntos
Bissexualidade/estatística & dados numéricos , Hepatite A/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adolescente , Adulto , Criança , Comorbidade , Contaminação de Alimentos , Infecções por HIV/epidemiologia , Hepatite A/prevenção & controle , Vacinas contra Hepatite A , Heterossexualidade/estatística & dados numéricos , Humanos , Incidência , Itália/epidemiologia , Masculino , Fatores de Risco , Viagem , Adulto JovemRESUMO
BACKGROUND: The independent role of hepatitis C virus (HCV) genotype 3 in liver transaminase elevation following highly active antiretroviral regimens is still controversial. METHODS: Analysis of data from a cohort of 492 HIV/HCV-coinfected patients was conducted using an intention-to-treat approach. Incidence of grade > or = III liver transaminase elevation was estimated per 100 patient-years of follow-up. Univariate and multiple proportional hazards regression analysis of factors that may predict liver enzyme elevation was performed. RESULTS: The incidence of grade > or = III hepatotoxicity was 25 per 100 patient-years among patients coinfected with HCV genotype 3 and 11 per 100 patient-years among those with other genotypes. On multiple proportional hazard regression analysis, time-to-grade > or = III liver enzyme elevation was directly correlated with HCV genotype 3 (hazards ratio [HR]: 2.0, 95% CI: 1.3 to 2.9; P = 0.001), male gender (HR: 2.7; 95% CI: 1.3 to 5.7; P = 0.007), chronic hepatitis B virus infection (HR: 2.9, 95% CI: 1.5 to 5.9; P = 0.002), and alanine aminotransferase level at baseline (per 10 IU/L HR: 1.10; 95% CI: 1.06 to 1.15; P < 0.001). In the same model, higher CD4 T-cell counts at baseline were inversely correlated with risk of hepatotoxicity (HR: 0.998; 95% CI: 0.997 to 0.999; P = 0.036). Moreover, among patients experienced to antiretroviral drugs, previous grade > or = III hepatotoxicity (HR: 2.8; 95% CI: 1.8 to 4.3; P < 0.001) was an adjunctive independent risk factor. CONCLUSIONS: HIV-positive patients coinfected with HCV genotype 3 displayed a higher risk of relevant hepatotoxicity, independently from other clinical variables. The impact of HCV genotype outweighed the role of drugs in determining hepatotoxicity.