Epidemiological surveillance of West Nile neuroinvasive diseases in Italy, 2008 to 2011

Binary file ES_Abstracts_Final_ECDC.txt matches

Epidemiological surveillance of West Nile neuroinvasive diseases in Italy, 2008 to 2011

We describe the geographical and temporal distribution of West Nile neuroinvasive diseases (WNND) cases in Italy from 2008 to 2011. The increasing number of confirmed human cases from eight in 2008 to 18 in 2009 and the occurrence of the virus in a larger geographical area in 2009 (moving from east to west) prompted the Ministry of Health to publish, in spring 2010, a national programme for WNND human surveillance, comprising veterinary and vector surveillance. Subsequently, in 2011, a new national plan on integrated human surveillance of imported and autochthonous vector-borne diseases (chikungunya, dengue and West Nile disease) was issued. Between 2008 and 2011, 43 cases of WNND were reported from five regions in Italy with a case fatality rate of 16%. The incidence of WNND during the entire study period was 0.55 per 100,000 population (range: 0.06–0.23 per 100,000). During 2011, two new regions (Friuli-Venezia Giulia and Sardinia) reported confirmed cases in humans. Integrated human, entomological and animal surveillance for West Nile virus is a public health priority in Italy and will be maintained during 2012.

Syndromic surveillance of epidemic-prone diseases in response to an influx of migrants from North Africa to Italy, May to October 2011

Following civil unrest in North Africa early in 2011, there was a large influx of migrants in Italy. A syndromic surveillance system was set up in April to monitor the health of this migrant population and respond rapidly to any health emergency. In the first six months, the system produced 67 alerts across all syndromes monitored and four alarms. There were no health emergencies, however, indicating that this migration flow was not associated with an increased risk of communicable disease transmission in Italy.

Photon regeneration experiment for axion search using x-rays

In this Letter we describe our novel photon regeneration experiment for the axionlike particle search using an x-ray beam with a photon energy of 50.2 and 90.7 keV, two superconducting magnets of 3 T, and a Ge detector with a high quantum efficiency. A counting rate of regenerated photons compatible with zero has been measured. The corresponding limits on the pseudoscalar axionlike particle-two-photon coupling constant is obtained as a function of the particle mass. Our setup widens the energy window of purely terrestrial experiments devoted to the axionlike particle search by coupling to two photons. It also opens a new domain of experimental investigation of photon propagation in magnetic fields.

Response to the 2009 influenza A(H1N1) pandemic in Italy

Binary file ES_Abstracts_Final_ECDC.txt matches

[Bone quality evaluation in allograft hand transplant]

Five bilateral forearms allograft have been performed between January 2000 and July 2009 in Lyon (France). The first four patients (three males, one female) have been the subject of an assessment of the bone quality of those allografts. The techniques selected for this study were: radioclinical analysis, bone scintigraphy, MRI, bone densitometry and High Resolution peripheral Quantitative Computed Tomography (HR-PQCT). Histology has been performed only on the first patient unilaterally grafted in 1998 who did not take part in this clinical research protocol, after amputation of his rejected graft. On the clinical, radiological and scintigraphical aspects, donor bone integration in hands allograft are good on a macroscopic point of view considering the healing and the general reaction of the bone in situation of fractures, infection and growth. The scintigraphy does not show important variations compared to the ones we can observe on contact with osteosynthesis material or during bone autografts. MRI found neither focal nor periosteal anomaly on grafted bone. The bone densitometry did not show significant difference with secondary osteoporosis one can observe in other grafted patients under immunosuppressive treatment. The HR-PQCT showed for the three males patients, a higher loss in volumetric density, for grafted bone than in the recipient patient control skeleton. Due to the few patients of this series, and the discrepancies in follow-up duration, the presented data have to be confirmed with further studies.

Age-related inflammation: the contribution of different organs, tissues and systems. How to face it for therapeutic approaches

A typical feature of ageing is a chronic, low-grade inflammation characterized by a general increase in the production of pro-inflammatory cytokines and inflammatory markers ("inflamm-ageing"). This status may slowly damage one or several organs, especially when unfavorable genetic polymorphisms and epigenetic alterations are concomitant, leading to an increased risk of frailty together with the onset of age-related chronic diseases. The contribution of different tissues (adipose tissue, muscle), organs (brain, liver), immune system and ecosystems (gut microbiota) to age-related inflammation ("inflamm-ageing") will be discussed in this review in the context of its onset/progression leading to site-restricted and systemic effects. Moreover, some of the possible strategies and therapies to counteract the different sources of molecular mediators which lead to the age-related inflammatory phenotype will be presented.

Visual evoked potentials in succinate semialdehyde dehydrogenase (SSADH) deficiency

In mammals, increased GABA in the central nervous system has been associated with abnormalities of visual evoked potentials (VEPs), predominantly manifested as increased latency of the major positive component P100. Accordingly, we hypothesized that patients with a defect in GABA metabolism, succinate semialdehyde dehydrogenase (SSADH) deficiency (in whom supraphysiological levels of GABA accumulate), would manifest VEP anomalies. We evaluated VEPs on two patients with confirmed SSADH deficiency. Whereas the P100 latencies and amplitudes for binocular VEP analyses were within normal ranges for both patients, the P100 latencies were markedly delayed for left eye (OS) (and right eye (OD), patient 1) and monocular OS (patient 2): 134-147 ms; normal <118 ms. We hypothesize that elevated GABA in ocular tissue of SSADH patients leads to a use-dependent downregulation of the major GABAergic receptor in eye, GABA(C), and that the VEP recordings' abnormalities, as evidenced by P100 latency and/or amplitude measurements, may be reflective of abnormalities within visual systems. This is a preliminary finding that may suggest the utility of performing VEP analysis in a larger sample of SSADH-deficient patients, and encourage a neurophysiological assessment of GABA(C) receptor function in Aldh5a1(-/-) mice to reveal new pathophysiological mechanisms of this rare disorder of GABA degradation.

West Nile virus transmission with human cases in Italy, August - September 2009

In 2009, to date 16 human cases of West Nile neuroinvasive disease (WNND) have been reported in Italy, in three regions: Veneto, Emilia-Romagna and Lombardia. The number of cases is higher compared with last year when nine cases were identified (eight cases of WNND and one case of West Nile fever) and the geographical distribution indicates spread from east to west.

West Nile virus transmission with human cases in Italy, August - September 2009

In 2009, to date 16 human cases of West Nile neuroinvasive disease (WNND) have been reported in Italy, in three regions: Veneto, Emilia-Romagna and Lombardia. The number of cases is higher compared with last year when nine cases were identified (eight cases of WNND and one case of West Nile fever) and the geographical distribution indicates spread from east to west.

Enhanced epidemiological surveillance of influenza A(H1N1)v in Italy

As of 7 July 2009, a total of 158 laboratory-confirmed cases of influenza A(H1N1)v were reported in Italy, from half of the 21 Italian regions. To date all cases have had symptoms consistent with seasonal influenza and no severe or fatal cases have been reported. An active surveillance of cases has been set up in Italy in order to undertake appropriate measures to slow down the spread of the new virus. This report describes the routine and enhanced surveillance currently ongoing in Italy.

RAPD profiles distinguish Paracentrotus lividus populations living in a stressing environment (Amvrakikos Gulf, Greece)

Random amplified polymorphic DNA (RAPD) analysis was performed to assess genetic markers of Paracentrotus lividus populations living in stressing environment in the Amvrakikos Gulf (Western Greece, Ionian Sea) where two populations distinguishable in body size, smaller than the open sea ones, were detected. The UPGMA dendrogram, constructed from pairwise. Phi(st) values among population nuclear DNA markers, revealed that the small and medium-sized populations living inside the Amvrakikos presented a lower polymorphism, and form a cluster that shows the genetic distance with normal-sized populations (Ionian and Tyrrhenian Seas) living in open sea. AMOVA analysis indicated a genetic distance among the sea urchin populations from the Tyrrhenian sea and Ionian sea.

Hepatitis A seroprevalence in Tuscany, Italy

Information regarding the current seroprevalence of hepatitis A virus (HAV) is useful for the control of HAV infections. The objective of our study was to evaluate the prevalence of anti-HAV antibodies among children (1-5 years old) and young adults (15-20 years old) in Tuscany, in central Italy. A total of 565 sera were collected in three years 1992, 1998 and 2004, equally distributed between the two age groups. The overal proportion of those that tested positive for anti-HAV antibodies was 8.3%. The proportion of immune children (1-5 years old) statistically significantly increased over the years. The percentage of immune subjects among 15-20-year-old young adults varied over the years, not showing a significant statistical trend, nevertheless our findings indicate that in a low endemicity area, adolescents and young adults are becoming increasingly susceptible to HAV infection. On-going monitoring of immunity to HAV is necessary for detecting trends over time.

Hepatitis A seroprevalence in Tuscany, Italy

Information regarding the current seroprevalence of hepatitis A virus (HAV) is useful for the control of HAV infections. The objective of our study was to evaluate the prevalence of anti-HAV antibodies among children (1-5 years old) and young adults (15-20 years old) in Tuscany, in central Italy. A total of 565 sera were collected in three years 1992, 1998 and 2004, equally distributed between the two age groups. The overal proportion of those that tested positive for anti-HAV antibodies was 8.3%. The proportion of immune children (1-5 years old) statistically significantly increased over the years. The percentage of immune subjects among 15-20-year-old young adults varied over the years, not showing a significant statistical trend, nevertheless our findings indicate that in a low endemicity area, adolescents and young adults are becoming increasingly susceptible to HAV infection. On-going monitoring of immunity to HAV is necessary for detecting trends over time.

Design of an advanced temporary hip prosthesis for an effective recovery of septic mobilizations: a preliminary study

The purpose of this study was the design and preliminary feasibility study of an advanced temporary hip prosthesis acting as an in-site drug dispensing system. An interactive device was designed to improve the recovery of bone infections compared to the mechanical spacers currently used in septic mobilizations. A commercial device was chosen and modified specifically for the purpose. First of all, the device was provided with a hydraulic multi-channel system connected via catheter to a subcutaneous valve, refillable with a drug aqueous solution from the outside. Moreover, since it allows samples of biological fluids for analyses to be drawn directly from the implantation site, this chemical dispensing system was designed to allow the course of infections to be monitored and customized therapies to be dosed. The insertion of biocompatible membranes inside the channel ends was considered essential to prevent their occlusion by fibrous tissue growth, thereby preserving the device functionality. Moreover, a biodegradable spongy ring was designed to be fixed onto the stem in distal position both to give primary stability to the implant and to act simultaneously as a scaffold for bonelike cell growth.

Autochthonous chikungunya virus transmission may have occurred in Bologna, Italy, during the summer 2007 outbreak

In Italy, a national surveillance system for chikungunya fever coordinated by the National Public Health Institute has been in place since August 2006. In summer 2007, an outbreak of chikungunya fever affected the Italian provinces of Ravenna, Cesena-Forli and Rimini [1-3]. As of 16 December 2007, health authorities identified 214 laboratory-confirmed cases with date of onset from 15 July to 28 September 2007. Most cases (161) occurred in the two neighbouring villages of Castiglione di Cervia and Castiglione di Ravenna, but limited local transmission also took place in the cities of Ravenna, Cesena, Cervia, and Rimini. In September 2007, two confirmed cases (two women aged 68 and 70) were reported among residents of the city of Bologna (373,026 inhabitants). Both had a history of travel in the affected areas (municipality of Cervia). No unusual increase in the density of Aedes albopictus mosquitoes in the Bologna area was noted at that time (September).

No "light shining through a wall": results from a photoregeneration experiment

Recently, axionlike particle search has received renewed interest. In particular, several groups have started "light shining through a wall" experiments based on magnetic field and laser both continuous, which is very demanding in terms of detector background. We present here the 2sigma limits obtained so far with our novel setup consisting of a pulsed magnetic field and a pulsed laser. In particular, we have found that the axionlike particle two photons inverse coupling constant M is >8 x 10{5} GeV provided that the particle mass m{a} approximately 1 meV. Our results definitively invalidate the axion interpretation of the original PVLAS optical measurements with a confidence level greater than 99.9%.

Allogreffe de mains: expérience lyonnaise

Hand allograft is a method in the stage of clinical experimentation, which is reserved in France for the treatment of bilateral traumatic amputees. This study reports the Lyon team experience, which is pioneer in this domain. Four patients (3 males and 1 female) underwent seven (one unilateral and three bilateral) hand transplantations from September 1998 to February 2007. The level of amputation was at the wrist or at the mid-forearm. Delay since hand loss ranged from 2.5 to 9 years. The surgical protocol was elaborated and planned case by case. All recipients received the same immunosuppressive treatment. Episodes of acute rejection were observed in the first 3 months after transplantation, which were easily managed after a few days increasing oral prednisone doses and applying topical immunosuppressants. Currently the patients receive the doses of immunosuppressants comparable to those in kidney-grafted patients. We have not registered any severe complication of immunosuppressive treatment up till now (7 years follow-up for the earliest graft). We performed analytical and functional clinical, as well as questionnaire evaluation of patients. The first case (unilateral graft) resulted in graft failure at 2 years due to non-compliance of the patient. The three bilateral graftees demonstrate a favorable evolution despite some immunological (hyperglycemia, serum sickness) and surgical (thrombosis, osteomyelitis, skin loss) complications, which could be managed. The middle and long-term follow-up evaluation revealed good to excellent sensorimotor recovery of 4 hands in both male recipients (4 and 7 years) with satisfactory social adaptation, higher or equal to those expected after post-traumatic replantations at the equivalent level and higher to those obtained with currently available myoelectric prosthesis. The last patient, a young female who has been grafted in February 2007, receives ongoing reeducation course and shows normal progress of functional restoration of both hands. The encouraging results of this clinical experimentation make us currently consider hand allografting as reasonable and useful both for the patients and for evolution of research in composite tissues allotransplantation (CTA). Further long-term careful research and worldwide monitoring of all patients with hand allografts is required to, on the one part, state on the authorization of this surgery, and, on the other part, to better elucidate the mechanisms of successful CTA.

Amebic liver abscess: report of three cases

Amebic abscess is a common manifestation of extraintestinal amebiasis and it is associated with relatively high morbidity and mortality. We present three cases seen in Bari, Southern Italy, one of which was autochthonous and the other two were not. Diagnosis was performed by elevated antibody titre for E. histolytica through immunofluorescence assay and positive antigen determination by ELISA in stools and in abscess aspirate. Fever often accompanied by chills, abdominal pain, weight loss and hepatomegaly were present. Laboratory findings also revealed leukocytosis with neutrophilia. Pleural effusion was observed in two patients. In all our patients multiple abscesses were observed. All the patients were treated with metronidazole and two of them also underwent the aspiration of the amoebic abscess. In all of them there was improvement of the clinical picture, as demonstrated by computerized tomography.

[Glutaric aciduria type I. Clinical, biochemical and molecular findings in six patients in Venezuela]

INTRODUCTION

Glutaric aciduria type I is an autosomal recessive inborn error of metabolism that is due to a deficiency of the enzyme glutaryl-CoA dehydrogenase, which gives rise to an accumulation of glutaric and 3-hydroxyglutaric acids in biological fluids. Clinical features present as a sudden-onset severe neurological disorder, characterised by extrapyramidal signs (dystonia-dyskinesia), hypotonia, irritability, macrocephaly and degeneration of the basal ganglia; it may also manifest with unspecific symptoms, such as hypotonia and psychomotor retardation.

AIMS

To describe the clinical, biochemical, neuroimaging and molecular aspects in six Venezuelan patients and to highlight the importance of an early diagnosis of glutaric aciduria type I so as to be able to establish early treatment and thus prevent the neurological damage produced by this disease.

CASE REPORTS

Two patients were referred because of macrocephaly, hypotonia and psychomotor retardation, and four more following an encephalopathic crisis. In all of them, neuroimaging studies showed delays in myelination, bilateral frontotemporal hypoplasia and symmetric widening of the Sylvian fissures with poor opercularisation. Urinary organic acid analyses showed raised levels of glutaric and 3-hydroxyglutaric acids, and a molecular analysis confirmed the diagnosis.

CONCLUSIONS

Organic acid analysis should be indicated in all patients who present macrocephaly, hypotonia, psychomotor retardation or an encephalopathic crisis of unknown causation. This study allowed us to determine the behaviour of the disease in Venezuela, since no epidemiological data exist in the country.

Effects of chronic treatment with statins and fenofibrate on rat skeletal muscle: a biochemical, histological and electrophysiological study

BACKGROUND AND PURPOSE

Skeletal muscle injury by hypolipidemic drugs is not fully understood. An extensive analysis of the effect of chronic treatment with fluvastatin (5 mgkg(-1) and 20 mgkg(-1)), atorvastatin (10 mgkg(-1)) and fenofibrate (60 mgkg(-1)) on rat skeletal muscle was undertaken.

EXPERIMENTAL APPROACH

Myoglobinemia as sign of muscle damage was measured by enzymatic assay. Histological and immunohistochemical techniques were used to estimate muscle integrity and the presence of aquaporin-4, a protein controlling water homeostasis. Electrophysiological evaluation of muscle Cl(-) conductance (gCl) and mechanical threshold (MT) for contraction, index of intracellular calcium homeostasis, was performed by the two-intracellular microelectrodes technique.

KEY RESULTS

Fluvastatin (20 mgkg(-1)) increased myoglobinemia. The lower dose of fluvastatin did not modify myoglobinemia, but reduced urinary electrolytes, suggesting direct effects on renal function. Atorvastatin also increased myoglobinemia, with slight effects on urinary parameters. No treatment caused any histological damage to muscle or modification in the number of fibres expressing aquaporin-4. Either fluvastatin (at both doses) or atorvastatin reduced sarcolemma gCl and changed MT. Both statins produced slight effects on total cholesterol, suggesting that the observed modifications occur independently of HMGCoA-reductase inhibition. Fenofibrate increased myoglobinemia and decreased muscle gCl, whereas it did not change the MT, suggesting a different mechanism of action from the statins.

CONCLUSIONS AND IMPLICATIONS

This study identifies muscle gCl and MT as early targets of drugs action that may contribute to milder symptoms of myotoxicity, such as muscle cramps, while the increase of myoglobinemia is a later phenomenon.

Food-borne outbreak caused by Salmonella enterica serovar Enteritidis in Bari, Italy

This paper presents data from an epidemiologic investigation of an outbreak of gastroenteritis that occurred in Bari, Southern Italy, in June 2005. The source of the outbreak was traced to consumption of rice "arancini" (a typical Italian food prepared with rice, mozzarella cheese, eggs and bread crumbs), prepared in a traditional bakery in town. Salmonella enteritidis strains were isolated from affected patients, bakery personnel and food items. Isolates were analysed by using traditional microbiological methods to determine their serotype, by testing resistance to antimicrobial agents, and by pulsed-field gel electrophoresis (PFGE) profiling. Epidemiologic investigation showed a strong association between the consumption of rice "arancini" and illness (RR: 7.0; 95% CI: 1.14 - 40.97; p < 0.001). All outbreak isolates of Salmonella enteriditis had identical PFGE patterns and this result confirmed the source of infection. The data obtained in this study confirms the value of molecular typing by PFGE, in epidemiologic investigations of outbreaks caused by S. enteritidis. With proper standardization, molecular typing of S. enteritidis strains, in conjunction with established typing methods, could eventually form the basis of an effective epidemiologic surveillance system that would be invaluable in developing rational strategies for control and better understanding of its pathogenicity for man.

The newly developed three-dimensional (3D) and two-dimensional (2D) thyroid ultrasound are strongly correlated, but 2D overestimates thyroid volume in the presence of nodules

The newly developed three-dimensional (3D) and two-dimensional (2D) thyroid ultrasound (US) were compared in assessing thyroid volume (TV) in 104 patients: 53 had an isolated thyroid nodule, 32 toxic diffuse goiter, 17 non-toxic multinodular goiter, 1 toxic multinodular goiter and 1 a toxic adenoma. A real-time Technos apparatus (Esaote SpA, Italy) with a 7,5 MHz linear transducer was used. The volume of thyroid lobes by 2D was calculated according to the ellipsoid formula. In the same session, TV by 3D US was calculated using a probe tracking system (in vivo ScanNT Esaote 3.4 MedCom. Darmasdt) and software to reconstruct 3D images, directly giving the lobe volume. There was a very good agreement between 2D and 3D, but in 94/208 lobes with nodular lesions 2D showed a 10% systematic overestimation compared to 3D, the percentage error being higher in lobes with lower volumes. A possible explanation for this result is the inadequacy of the ellipsoid formula in forecasting the correct lobe profile in the presence of nodules. This intrinsic defect of 2D US should be taken into account when evaluating TV in patients with nodular goiter.

A single-residue mutation, G203E, causes 3-hydroxy-3-methylglutaric aciduria by occluding the substrate channel in the 3D structural model of HMG-CoA lyase

3-Hydroxy-3-methylglutaric aciduria is a rare autosomal recessive genetic disorder that affects ketogenesis and leucine metabolism. The disease is caused by mutations in the gene coding for 3-hydroxy-3-methylglutaryl-coenzyme A lyase (HL). To date 26 different mutations have been described. A (betaalpha)(8) TIM barrel structure has been proposed for the protein, and almost all missense mutations identified so far localize in the beta sheets that define the inside cavity. We report an Italian patient who bears homozygously a novel HL mutation, c.608G > A (p. G203E) in beta sheet six. A structural model of the mutated protein suggests that glutamic acid 203 impedes catalysis by blocking the entrance to the inner cavity of the enzyme. Loss of functionality has been confirmed in expression studies in E. coli, which demonstrate that the G203E mutation completely abolishes enzyme activity. Beta sheet six and beta sheet two are the two protein regions that accumulate most missense mutations, indicating their importance in enzyme functionality. A model for the mechanism of enzyme function is proposed.

Direct characterization of human T cells in pemphigus vulgaris reveals elevated autoantigen-specific Th2 activity in association with active disease

Pemphigus vulgaris (PV) is a blistering skin disorder mediated by autoantibodies targeting the epidermal adhesion molecule desmoglein 3 (Dsg3). As Th2-associated cytokines are necessary for directing antibody production, it is hypothesized that Dsg3-specific Th2 activity is associated with active disease. We used cell-surface-matrix technology in combination with flow cytometry to characterize the Dsg3-reactive T-cell population using peripheral blood mononucleocytes sampled from PV patients stratified by active (n = 9) or remittent disease (n = 6), and healthy human leucocyte antigen-matched controls (n = 5). We evaluated interferon-gamma-producing CD4+ cells (Th1) and interleukin (IL)-10- or IL-4-producing CD4+ cells (Th2). The mean frequency of Th2 CD4+ T cells was significantly elevated for five of nine PV patients with active disease. No significant Th2 responses were detected for patients with remittent disease or controls. There was a significant association of Th2 activity with active disease compared with remittent and control groups (P = 0.026 and P =0.012, respectively), and Th2 activity was significantly correlated with anti-Dsg3 IgG titre (P = 0.044). One patient with remittent disease converted from a Th2-negative to a Th2-positive response with the initiation of disease activity. An antigen-specific CD4- lymphocyte response was detected in five PV patients (36%), and was shown to correlate closely with the CD8+ population. These results are consistent with the hypothesis that Th2 response directs autoantibody production and is therefore associated with disease activity in PV.

Spontaneous Ocular Squamous Cell Carcinoma in Twin Goats: Pathological and Biomolecular Studies

Ocular squamous cell carcinoma (OSCC) is a well-characterized tumour occurring spontaneously in cattle and other mammalian species but not previously reported in the goat. This report describes the histological features of well-differentiated OSCCs in twin goats. Biomolecular investigations led to the identification of Papillomavirus-related DNA sequences within the neoplastic ocular parenchyma of both animals, but immunohistochemical and ultrastructural studies failed to demonstrate viral particles. A putative role of Papillomavirus in the aetiology of OSCC is discussed, together with other possible causative factors.

Presence of HPV in head and neck tumours: high prevalence in tonsillar localization

Human papillomavirus (HPV) seems to be involved in head and neck carcinogenesis. To investigate this association, viral presence and expression were analysed by polymerase chain reaction (PCR)-based methods and correlated to tumour localization, clinical-pathological aspects, and alcohol and tobacco exposure in 65 patients. HPV DNA was found in 16 cases (24.6%); the HPV types detected were: HPV16 (10 cases), HPV 6 (3 cases) HPV 33, 35, and 58 (one case each). The tonsil was the location with the highest HPV positivity (6/8, 75%). This percentage was significantly higher than that found in tumours from any other site (P<0.01). Viral transcripts of early regions were detected in all HPV16 positive tumours. HPV status was not related to age, gender, tumour stage or grade, and use of alcohol and/or tobacco. The results suggest that HPV16 is actively involved in the genesis of a subset of head and neck cancers and that the tonsillar localization may be considered a hot spot for viral transformation.

[In utero macrocephaly as clinical manifestation of glutaric aciduria type I. Report of a novel mutation]

INTRODUCTION

Macrocephaly is a pivotal clinical sign, associated with multiple neurological diseases, particularly neurometabolical ones, such as the glutaric aciduria type I (GA I). This aciduria resulting from the genetical deficiency of the enzyme glutaryl-CoA dehydrogenase (GCDH). Is a relatively common cause of acute metabolic brain damage in early childhood. We report on one case of GA I, with early manifestations since fetal period and a novel mutation.

CASE REPORT

Our patient was referred due macrocephaly in utero and occipitofrontal head circumference above the 98 percentile for chronologic age during first few months of life, hypotonia and development delay. The metabolic investigations of organic acids in urine and acylcarnitine profile in blood, the brain magnetic resonance and the molecular analyses of the glutaryl-CoA deshidrogenase gene, confirm the diagnosis. The molecular analysis allowed to identify one previously described mutation A293T and a novel mutation IVS5-2 A>G.

CONCLUSION

It is important the recognition of in utero macrocephaly as a sign to early diagnosis of glutaric aciduria type I to initiate specific therapy to prevent the encephalopathic crises and minimize brain damage in patients who are already neurologically impaired.

A randomized trial of prolonged high dose of interferon plus ribavirin for hepatitis C patients nonresponders to interferon alone

Retreatment of chronic hepatitis C patients nonresponders to interferon (IFN) alone with the standard dose of IFN [3 million units (MU) thrice weekly (TIW)] plus ribavirin for 24 weeks has yielded low sustained virological response (SVR), averaging 8%. The aim of the present, open-labelled, randomized study was to evaluate the efficacy of IFN induction therapy followed by prolonged high dose of IFN plus ribavirin in nonresponders. One hundred and fifty-one patients were randomized to receive 5 MU daily of IFN alfa-2b (group 1, n = 73) or 5 MU TIW of IFN alfa 2b (group 2, n = 78) for 4 weeks followed by IFN (5 MU TIW) plus ribavirin (1000/1200 mg/daily) for 48 weeks in both groups. In an intention-to-treat analysis, the sustained virological response (SVR) at 24-week follow-up was 33 and 23% for group 1 and 2, respectively (P = 0.17). The overall SVR was 52 and 18% in patients with genotype 2/3 and 1/4, respectively. Among genotype 1/4 patients the SVR was 29 and 11% for age younger or older than 40 years. Compared with genotype 2/3 patients, the risk (95% confidence interval) of nonresponse to retreatment was 3.0-fold (1.17-8.0) in younger genotype 1/4 patients and 8.4-fold (3.0-23.29) in older genotype 1/4 patients. In conclusion these results suggest that retreatment with a reinforced regimen should be focused in nonresponder genotype 2/3 patients and younger genotype 1/4 patients, who are most likely to benefit. Induction therapy does not improve SVR.

Campylobacter fetus bacteremia in an immunocompromised patient: case report and review of the literature

A 33-year-old woman underwent a liver transplantation and splenectomy in 1985 and had followed immunosuppressive therapy until 1995. Afterwards a non-Hodgkin lymphoma was diagnosed and chemotherapy was started. In January 2000, because of suspect transplantation rejection she was treated with steroid and immunosuppressive therapy. Fever occurred after two months and Cytomegalovirus (CMV) infection was diagnosed. Ganciclovir was started with clinical remission. In November 2000 fever recurred without clinical symptoms. Lymphoma recurrence was excluded and CMV was detected by PCR in several biological fluids. Blood cultures were positive for a bacterium that was identified as Campylobacter fetus. The patient was successfully treated with intravenous ciprofloxacin. For persistent CMV viremia therapy with gancyclovir was stopped and foscarnet was used (60mg/Kg/tid i.v. for two weeks). Bacteremia due to C. fetus is rare, occurring mainly in immunocompromised patients. In our patient the immunosuppressive therapy, chemotherapy for lymphoma and CMV infection had made the patient susceptible to bacteremia with this infrequently found bacterium. The clinical microbiologist should be aware of this infection in immunocompromised hosts.

Inborn errors of metabolism: an update on epidemiology and on neonatal-onset hyperammonemia

Inborn errors of metabolism (IEM) are a highly heterogeneous group of genetic conditions and represent a relevant cause of morbidity and mortality in the pediatric population. IEM, which are individually rare but collectively numerous, are well-recognized entities of the generic class of "rare" diseases. Since the first descriptions by Garrod at the beginning of the 20th century, several hundred new disorders have been defined, as new biochemical and molecular diagnostic tools became available. The clinical pictures of single diseases are extremely diverse, ranging from acute life-threatening manifestations to chronic late-onset forms, with single or multiorgan involvement. Mental retardation and progressive neurological impairment often characterize the clinical course. One of the principles to prevent high morbidity and mortality rates is early recognition followed by prompt therapeutic intervention. Therefore, a small number of treatable IEM is subject to neonatal mass screening. More recently, an innovative technique, based on tandem mass spectrometry, has expanded the range of neonatal screening to several additional disorders. Owing to the extreme heterogeneity, as well as to the increasing number of new disorders, exhaustive and updated epidemiological data on the overall occurrence of IEM are lacking. A national retrospective study was conducted to define the epidemiological profile of IEM in Italy and to estimate the costs related to the disease burden. Other relevant issues of our investigations focused on creating protocols of treatment for neonatal IEM, and on the development of new methods for the biochemical diagnosis.

[Preliminary surveys about the use of "Mytilus galloprovincialis" as an accumulation matrix of bacteria in coastal waters]

A biomonitoring study using "Mytilus galloprovincialis" mussels was carried out, to estimate their possible employment as "natural indicators" of coastal bacterial pollution. The research was conducted from September 2001 to May 2002, twice in a month, near two coastal zones of Salento. We analysed both natural and cultivated mussels. The latter were placed in cages, after checking their starting level of microbiological pollution. The bacteriological analyses conducted simultaneously on mussels and their ambient water, were directed to the search of: total and faecal coliforms, faecal streptococci, Escherichia coli, Salmonella spp., Staphylococcus aureus and yeasts. In this preliminary study the mussels proved to be "sensitive indicators of faecal pollution", since they had an accumulation of the faecal indicators even if the water was not contaminated. Nevertheless a lower frequency in finding yeasts in the mussels (53.8%) in comparison with water (74.3%), the irregular presence of Salmonella spp. in water (3.75%) and its absence in bivalves, show the need of further studies, also through "in vitro" tests, in order to verify absorption/elimination kinetics of microorganisms.

Efficacy of prolonged 5 million units of interferon in combination with ribavirin for relapser patients with chronic hepatitis C

summary. Retreatment of relapser patients with chronic hepatitis C with the standard dose of interferon (IFN) of 3 million units (MU) thrice weekly (tiw) plus ribavirin for 24 weeks achieves a sustained response in 30 and 73% of patients with genotype 1 and 2 or 3, respectively. The aim of this study was to evaluate the efficacy and safety of IFN alpha-2b induction therapy, followed by prolonged treatment with a high dose of IFN alpha-2b plus ribavirin in relapser patients. A total of 119 patients were randomized to receive IFN alpha-2b 5 MU daily (Group A: 59 patients) or IFN alpha-2b 5 MU tiw (Group B: 60 patients) for 4 weeks followed by IFN (5 MU tiw) and ribavirin (1000-1200 mg/day) for 48 weeks in both groups. The primary end point was hepatitis C virus (HCV)-RNA clearance at week 24 after the end of treatment. A sustained virological response (SVR) was achieved in 68 and 60% of Group A and B patients, respectively (P = 0.37). Logistic regression analysis identified genotype 2 or 3 as the only independent factor associated with response, whereas induction regimen and baseline viraemia levels did not affect the response. The overall SVR was 53 and 72% in patients with genotype 1 or 4 and 2 or 3, respectively. In conclusion, induction IFN therapy does not enhance the SVR to a 48-week combination therapy. Our study suggests that relapsed patients with genotype 1 or 4 may achieve significant response rates of approximately 50%, if retreated with 5 MU tiw IFN plus ribavirin for 48 weeks.

Evidence of a specific spinal pathway for the sense of warmth in humans

While research on human sensory processing shows that warm input is conveyed from the periphery by specific, unmyelinated primary sensory neurons, its pathways in the central nervous system (CNS) remain unclear. To gain physiological information on the spinal pathways that convey warmth or nociceptive sensations, in 15 healthy subjects, we studied the cerebral evoked responses and reaction times in response to laser stimuli selectively exciting Adelta nociceptors or C warmth receptors at different levels along the spine. To minimize the conduction distance along the primary sensory neuron, we directed CO(2)-laser pulses to the skin overlying the vertebral spinous processes. Using brain source analysis of the evoked responses with high-resolution electroencephalography and a realistic model of the head based on individual magnetic resonance imaging scans, we also studied the cortical areas involved in the cerebral processing of warm and nociceptive inputs. The activation of C warmth receptors evoked cerebral potentials with a main positive component peaking at 470-540 ms, i.e., a latency clearly longer than that of the corresponding wave yielded by Adelta nociceptive input (290-320 ms). Spinal neurons activated by the warm input had a slower conduction velocity (2.5 m/s) than the nociceptive spinal neurons (11.9 m/s). Brain source analysis of the cerebral responses evoked by the Adelta input yielded a very strong fit for one single generator in the mid portion of the cingulate gyrus; the warmth-related responses were best explained by three generators, one within the cingulate and two in the right and left opercular-insular cortices. Our results support the existence of slow-conducting second-order neurons specific for the sense of warmth.

[Evaluation of the Surveillance System of Acute Flaccid Paralysis in Puglia: 5 years of work]

Surveillance of acute flaccid paralysis (AFP) is the milestone to monitor the progress toward poliomyelitis eradication aim, fixed by WHA in 1988. Active AFP surveillance started in Apulia in 1997; this work evaluates five-year period activities. In this period, the total number of cases notified was 48, 7 of which were resident out of Apulia. Twenty-five were males and 23 females; the age ranged between 1 month and 15 years. Any collected serum specimens showed protective antibody levels against polioviruses. Polioviruses type 1 and type 2 Sabin-like were isolated from stool samples collected from two AFP patients. AFP surveillance targets improved in the years, with only exception, in 2001, of second serum specimen collected within 14 days because of children were discharged earlier form the hospitals. Apulia experience demonstrates the achievement of good levels of AFP surveillance targets. System sensitivity has been optimal in 2001 with a number of notified cases threefold the expected value and adequate specimen sampling (80%). Additional involved hospitals and availability of increased and dedicated human resources contributed to this outcome. The effort to achieve WHO targets for AFP surveillance needs to be maintained in next years until global certification of eradication will be declared.

[Comparative evaluation of 2 epidemiologic surveillance systems of hepatitis A]

Epidemiological surveillance represents an important tool for the prevention of hepatitis A. In Italy, the surveillance of hepatitis A is based on the routine notification system of infectious diseases (from 1996 it was replaced by SIMI, Computerised System of Infectious Diseases) and on SEIEVA (Epidemiological Integrated System of Acute Viral Hepatitis). From 1997 to 2000 the two surveillance systems have been compared in Puglia region to evaluate match rate, completeness and sensitivity. A total of 7.018 records from SIMI and 4.413 from SEIEVA have been analyzed. During this period, the 37.0% of cases notified to SIMI match SEIEVA records whereas the 58.8% of cases reported to SEIEVA match cases notified to SIMI. Therefore, the match rate between the two systems was 29.0%. The sensitivity of SIMI and SEIEVA resulted 79.4% and 49.9% respectively. The comparison of the two surveillance systems allowed to recognise problems in local organisation. Therefore, a more adequate training should be supplied to workers involved in the surveillance activities.