Emergency treatment of a salmonella-infected abdominal aortic aneurysm associated with spondylodiscitis.

AIM: To report surgical treatment of a ruptured abdominal aortic aneurysm (AAA) associated with spondylodiscitis due to Salmonella in emergency setting. CASE REPORT: A 69-year-old male with an history of hypertension, presented with a ruptured AAA infected by nontyphoidal Salmonella (type H), associated with spondylodiscitis. Patient underwent an emergency operation consisting in surgical debridment of infected tissue and aortic replacement with a prosthetic Dacron graft impregnated with Gentamycine. The postoperative course was uneventful and the patient was discharged at day 20 after the index procedure in good clinical condition. antimicrobial therapy was continued for 8 weeks. A CT scan and nuclear medicine studies performed two months later demonstrated minimal sign of residual aortitis. A CT scan 21 months after the procedure showed complete anatomic resolution of the disease. CONCLUSIONS: A rare but increasing number of aneurysms as a consequence of Salmonellosis can be observed with a high rate of morbidity and mortality, mainly in patients with a concurrent infection of the spine and paravertebral tissue. Combined antimicrobial therapy and one-stage surgical treatment can be associated with good outcome. KEYWORDS: Abdominal aorta aneurysm, Mycotic aortic aneurysms, Salmonellosis, Spondylodiscitis.

Inhibitors of multidrug resistant efflux systems in bacteria.

Resistance of bacteria to many classes of antibiotics is an increasing problem worldwide. Multidrug resistance efflux pumps are recognized as an important component of resistance in both Gram-positive and Gram-negative bacteria. Some bacterial efflux pumps may be selective for one substrate, such as tetracycline, or transport antibiotics of different classes, conferring a multiple drug resistance (MDR) phenotype. Efflux pump inhibitors (EPIs) are promising therapeutic agents, as they should restore the activity of standard antibiotics. The efflux pump inhibitor-antibiotic combination is expected to increase the intracellular concentration of antibiotics that are expelled by efflux pumps, decrease the intrinsic bacterial resistance to antibiotics, reverse the acquired resistance associated with efflux pumps overexpression, and reduce the frequency of the emergence of resistant mutant strains. In recent years, different classes of EPIs have been described and tested, including analogues of antibiotic substrates and new molecules. This review focuses on the families of MDR efflux pumps, and on the current progress for the clinical use of EPIs. The present article is a good review of the recent patents related to efflux pump inhibitors.

A case report of pityriasis lichenoides in a patient with chronic hepatitis C.

The authors describe a case of chronic hepatitis C associated with pityriasis lichenoides. The association and evolution during antiviral treatment of these two diseases in this patient point to a possible pathogenetic link between chronic C virus infection and pityriasis lichenoides.

Antibody-selected mimics of hepatitis C virus hypervariable region 1 activate both primary and memory Th lymphocytes.

An ideal strategy that leads to a vaccine aimed at controlling viral escape may be that of preventing the replication of escape mutants by eliciting a T- and B-cell repertoire directed against many viral variants. The hypervariable region 1 (HVR1) of the putative envelope 2 protein that presents B and T epitopes shown to induce protective immunity against hepatitis C virus (HCV), might be suitable for this purpose if its immunogenicity can be improved by generating mimics that induce broad, highly cross-reactive, anti-HVR1 responses. Recently we described a successful approach to select HVR1 mimics (mimotopes) incorporating the variability found in a great number of viral variants. In this report we explore whether these mimotopes, designed to mimic B-cell epitopes, also mimic helper T-cell epitopes. The first interesting observation is that mimotopes selected for their reactivity to HVR1-specific antibodies of infected patients also do express HVR1 T-cell epitopes, suggesting that similar constraints govern HVR1-specific humoral and cellular immune responses. Moreover, some HVR1 mimotopes stimulate a multispecific CD4(+) T-cell repertoire that effectively cross-reacts with HVR1 native sequences. This may significantly limit effects as a T-cell receptor (TCR) antagonist frequently exerted by natural HVR1-variants on HVR1-specific T-cell responses. In conclusion, these data lend strong support to using HVR1 mimotopes in vaccines designed to prevent replication of escape mutants.