Azole-resistant Aspergillus fumigatus in the environment of northern Italy, May 2011 to June 2012.

In recent years acquired azole resistance in Aspergillus fumigatus has been increasingly reported and a dominant mechanism of resistance (TR34/L98H) was found in clinical and environmental isolates. The aim of the present study was to investigate the prevalence of azole resistance in environmental A. fumigatus isolates collected in northern Italy. A. fumigatus grew from 29 of 47 soil samples analysed. Azole-resistant isolates were detected in 13% (6/47) of the soil samples and in 21% (6/29) of the soil samples containing A. fumigatus. High minimal inhibitory concentrations (MIC) of itraconazole (≥16 mg/L) and posaconazole (≥0.5 mg/L) were displayed by nine isolates from six different soil samples, namely apple orchard (1 sample), rose pot compost (2 samples), and cucurbit yields (3 samples). Seven isolates had a MIC=2 mg/L of voriconazole. Seven of nine itraconazole and posaconazole resistant isolates harboured the same TR34/L98H mutation of cyp51A. These findings, together with the occurrence of resistant clinical isolates, suggest that azole resistance should be considered in primary patient care.

Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy.

OBJECTIVES: This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates from patients with haematological malignancies or who were undergoing haematopoietic stem cell transplantation and to identify the molecular mechanism of resistance. METHODS: In this 28-month prospective study involving 18 Italian centres, Aspergillus isolates from surveillance cultures were collected and screened for azole resistance, and mutations in the cyp51A gene were identified. Resistant isolates were genotyped by microsatellite analysis, and the allelic profiles were compared with those of resistant environmental and clinical isolates from the same geographical area that had been previously genotyped. RESULTS: There were 292 Aspergillus isolates collected from 228 patients. The isolates belonged mainly to the section Fumigati (45.9%), Nigri (20.9%), Flavi (16.8%) and Terrei (4.8%). Three isolates showed itraconazole resistance: Aspergillus fumigatus sensu stricto, Aspergillus lentulus (section Fumigati) and Aspergillus awamori (section Nigri). The itraconazole resistance rates were 1% and 1.48% considering all Aspergillus spp. isolates and the Aspergillus section Fumigati, respectively. The prevalence of azole resistance among all the patients was 1.3%. Among patients harbouring A. fumigatus sensu stricto isolates, the resistance rate was 0.79%. The A. fumigatus isolate, with the TR34/L98H mutation, was genotypically distant from the environmental and clinical strains previously genotyped. CONCLUSIONS: In this study, the Aspergillus azole resistance rate was 1% (3/292). In addition to A. fumigatus sensu stricto, A. lentulus and A. awamori azole-resistant isolates were identified. Therefore, it is important have a correct identification at the species level to address a rapid therapy better, quickly understand the shift towards cryptic species and have an updated knowledge of the local epidemiology.

Hydroxyproline and zinc excretion in patients with neoplastic breast disease.

Hydroxyproline and zinc excretion was evaluated in 87 patients with neoplastic breast disease; 40 of these had carcinoma, without radiological and scintigraphy demonstration of bone metastases. In the group of patients with breast cancer, the mean values of hydroxyproline and zinc excretion were found to be significantly higher than in the group with benign breast disease; only 12 of the patients with histologically detected breast cancer had hydroxyprolinuria levels which were higher than the upper limit of the values obtained in the control group. The authors, therefore, conclude that the patients in this group must be considered as being at greater risk.

[Changes in the principal biohumoral parameters after jejuno-ileal bypass in rats with experimentally induced obesity (preliminary note)]. / Modificazioni dei principali parametri bio-umorali dopo by-pass digiuno-ileale praticato nel ratto con obesità sperimentalmente indotta. (Nota preliminare).

End-to-end jejuno-ileal by-pass is one of the most extensively used surgical procedure in the treatment of morbid obesity. The Authors evaluated hematologic indices in experimentally induced obese Sprague-Dowley rats and their modifications after jejuno-ileal by-pass. This surgical procedure induced a significant weight loss and a considerable improvement of glucidic and lipidic metabolic disorders, presents in experimentally obese rats. The Authors conclude that an intestinal by-pass preserving a jejuno-ileal tract with sufficient absorbtion potential, is able to induce adequate weight loss with regression of glucidic and lipidic metabolic disorders, in absence of heavy alterations of the others hematologic indices.

Calcitonin deficit syndrome in thyroidectomized patients.

The results of a study carried out on 10 patients who underwent total or subtotal thyroidectomy to determine the effects of a prolonged deficit in calcitonin on bone turnover, are reported. The following parameters were evaluated: serum calcium and phosphate, serum alkaline phosphatase, urinary hydroxyproline, serum iPTH, serum iCT and bone mineral content (BMC) of the distal radius. In ten patients controlled 24 months after surgery, a lowering in circulating iCT levels was noted together with a significant decrease in BMC. These observations while supporting the theory that a CT deficit can determine osteoporosis, suggest that further consideration should be given to substitutive therapies for totally and subtotally thyroidectomized patients.