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Riccardi N, Antonello RM, Giacomelli A, Saderi L, Canetti D, Pallotto C, Mazzaferri F, Degli Antoni AM, Cardellino C, Motta I, Calcagno A, Falcone M, Trezzi M, Comelli A, Pascale R, Merli M, Binda F, Angheben A, Sotgiu G, Gobbi F, Nozza S. The challenge of infectious diseases consultations in the emergency department: an Italian nationwide survey. New Microbiol 2022; 45:260-268. [PMID: 36190370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 06/16/2023]
Abstract
Diagnosis and management of infectious diseases (ID) at the emergency department (ED) are challenging due to the peculiar setting and the available diagnostic tools. The involvement of an ID consultant has been described to improve clinical outcomes and antimicrobial stewardship (AMS) programs. An online survey was sent to 100 Italian Departments of Infectious Diseases affiliated with the Italian Society of Infectious Diseases and Tropical Medicine (SIMIT). The primary objective of our study was to describe the characteristics of ID services in Italian EDs to identify possible challenges and shortcomings and provide tips to improve the management of patients. Secondary objectives included the evaluation of diagnostic capability and the management of patients with suspected or confirmed ID. Seventy-six out of the 100 SIMIT centers, 32 (42.1%) of which were teaching hospitals, answered the survey. In 62 (82.7%) centers, consultations were performed by the IDs specialist on call. In 29 (38.2%) centers, there was a formal AMS program, and 32 (42.7%) had protocols for antibiotic use in the ED. Microbiological tests to be performed before starting antibiotic treatment in the ED were clearly defined in 44 (57.9%) hospitals. This survey highlighted several challenges in the current organization of ID consultations in Italian EDs.
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Affiliation(s)
- Niccolò Riccardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Pisa, Italy
- StopTB Italia Onlus, Milan, Italy
| | | | - Andrea Giacomelli
- StopTB Italia Onlus, Milan, Italy
- Department of Biomedical and Clinical Sciences DIBIC L. Sacco, University of Milan, 20157 Milan, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Diana Canetti
- StopTB Italia Onlus, Milan, Italy
- Department of Infectious and Tropical Diseases San Raffaele Hospital, 20132 Milan, Italy
| | - Carlo Pallotto
- Infectious Diseases Unit, Santa Maria Annunziata Hospital, Azienda USL Toscana Centro, 50012 Bagno a Ripoli, Florence, Italy
| | - Fulvia Mazzaferri
- Infectious Diseases Section, Department of Diagnostic and Public Health, University of Verona, 37129 Verona, Italy
| | - Anna Maria Degli Antoni
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, 34126 Parma, Italy
| | - Chiara Cardellino
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Valpolicella di Negrar, Verona, Italy
| | - Ilaria Motta
- University of Turin, AO "Amedeo di Savoia", Department of Medical Sciences, Infectious Diseases, 10149 Turin, Italy
| | - Andrea Calcagno
- University of Turin, AO "Amedeo di Savoia", Department of Medical Sciences, Infectious Diseases, 10149 Turin, Italy
| | - Marco Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Michele Trezzi
- Division of Infectious Diseases, Azienda USL Toscana Centro, Hospital of Pistoia, 51100 Pistoia, Italy
| | - Agnese Comelli
- Department of Infectious & Tropical Diseases, Spedali Civili, 25123 Brescia, Italy
| | - Renato Pascale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Marco Merli
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Francesca Binda
- Division of Infectious Diseases, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Andrea Angheben
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Valpolicella di Negrar, Verona, Italy
| | - Giovanni Sotgiu
- StopTB Italia Onlus, Milan, Italy
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Federico Gobbi
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Valpolicella di Negrar, Verona, Italy
| | - Silvia Nozza
- Department of Infectious and Tropical Diseases San Raffaele Hospital, 20132 Milan, Italy
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Buonfrate D, Piubelli C, Gobbi F, Martini D, Bertoli G, Ursini T, Moro L, Ronzoni N, Angheben A, Rodari P, Cardellino C, Tamarozzi F, Tais S, Rizzi E, Degani M, Deiana M, Prato M, Silva R, Bisoffi Z. Antibody response induced by the BNT162b2 mRNA COVID-19 vaccine in a cohort of health-care workers, with or without prior SARS-CoV-2 infection: a prospective study. Clin Microbiol Infect 2021; 27:1845-1850. [PMID: 34329793 PMCID: PMC8316640 DOI: 10.1016/j.cmi.2021.07.024] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/18/2021] [Indexed: 11/19/2022]
Abstract
Objectives To assess the antibody response to BNT162b2 mRNA COVID-19 vaccine in a cohort of health-care workers (HCW), comparing individuals with previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and SARS-CoV-2-naive individuals. Methods HCW were tested at T0 (day of first dose), T1 (day of second dose) and T2 (2–3 weeks after second dose) for IgG anti-nucleocapsid protein, IgM anti-spike protein and IgG anti-receptor binding domain (IgG-RBD-S). The antibody response was compared between four main groups: group A, individuals with previous infection and positive antibodies at baseline; group B, individuals with the same history but negative antibodies; group C, individuals with no infection history but positive antibodies; group D, naive individuals. Repeated measures analysis was used to compare results over time-points. Results A total of 1935 HCW were included. Median IgG-RBD-S titre was significantly higher for group A (232 individuals) than for group B (56 individuals) both at T1 (A: 22 763 AU/mL, interquartile range (IQR) 14 222–37 204 AU/mL; B: 1373 AU/mL, IQR 783–3078 AU/mL, p 0.0003) and T2 (A: 30 765 AU/mL, IQR 19 841–42 813 AU/mL; B: 13 171 AU/mL, IQR 2324–22 688 AU/mL, p 0.0038) and for group D (1563 individuals; 796 AU/mL, IQR 379–1510 AU/mL at T1; 15 494 AU/mL, IQR 9122–23 916 AU/mL at T2, p < 0.0001 for both time-points). T1 values of group A were also significantly higher than T2 values of group D (p < 0.0001). Presence of symptoms, younger age and being female were associated with stronger antibody response. HCW infected in March showed a significantly stronger response (T1: 35 324 AU/mL, IQR 22 003–44 531 AU/mL; T2: 37 648 AU/mL, IQR 27 088–50 451 AU/mL) than those infected in November (T1: 18 499 AU/mL, IQR 11 492–27 283 AU/mL; T2: 23 210 AU/mL, IQR 18 074–36 086 AU/mL, p < 0.0001 for both time-points. Conclusions Individuals with past SARS-CoV-2 infection had a strong antibody response after one single vaccine shot. A single dose might be sufficient for this group, regardless of the time elapsed since infection; however, the clinical correlation with antibody response needs to be studied.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy.
| | - Chiara Piubelli
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Federico Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Davide Martini
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giulia Bertoli
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Tamara Ursini
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Lucia Moro
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Niccolò Ronzoni
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Andrea Angheben
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Paola Rodari
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Chiara Cardellino
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Stefano Tais
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Eleonora Rizzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Monica Degani
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Michela Deiana
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Marco Prato
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Ronaldo Silva
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Calleris G, Marra G, Corcione S, Oderda M, Cardellino C, Audagnotto S, Frea B, De Rosa FG, Gontero P. Miliary pulmonary infection after BCG intravesical instillation: a rare, misdiagnosed and mistreated complication. Infez Med 2017; 25:366-370. [PMID: 29286018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Intravesical Bacillus Calmette-Guérin (BCG) immunotherapy decreases the progression risk of non-muscle-invasive bladder cancer, but potentially yields a broad spectrum of side effects. We report the case of a 73-year-old man affected by miliary pulmonary BCG infection, whose microbiological diagnosis was probably hindered by empiric fluoroquinolones, focusing on imaging and clinical work-up.
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Affiliation(s)
- Giorgio Calleris
- University of Turin, AOU "Città della Salute e della Scienza di Torino", Department of Surgical Sciences, Urology, Turin, Italy
| | - Giancarlo Marra
- University of Turin, AOU "Città della Salute e della Scienza di Torino", Department of Surgical Sciences, Urology, Turin, Italy
| | - Silvia Corcione
- University of Turin, AO "Amedeo di Savoia", Department of Medical Sciences, Infectious Diseases, Turin, Italy
| | - Marco Oderda
- University of Turin, AOU "Città della Salute e della Scienza di Torino", Department of Surgical Sciences, Urology, Turin, Italy
| | - Chiara Cardellino
- University of Turin, AO "Amedeo di Savoia", Department of Medical Sciences, Infectious Diseases, Turin, Italy
| | - Sabrina Audagnotto
- University of Turin, AO "Amedeo di Savoia", Department of Medical Sciences, Infectious Diseases, Turin, Italy
| | - Bruno Frea
- University of Turin, AOU "Città della Salute e della Scienza di Torino", Department of Surgical Sciences, Urology, Turin, Italy
| | - Francesco Giuseppe De Rosa
- University of Turin, AO "Amedeo di Savoia", Department of Medical Sciences, Infectious Diseases, Turin, Italy
| | - Paolo Gontero
- University of Turin, AOU "Città della Salute e della Scienza di Torino", Department of Surgical Sciences, Urology, Turin, Italy
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Calcagno A, Romito A, Atzori C, Ghisetti V, Cardellino C, Audagnotto S, Scarvaglieri E, Lipani F, Imperiale D, Di Perri G, Bonora S. Blood Brain Barrier Impairment in HIV-Positive Naïve and Effectively Treated Patients: Immune Activation Versus Astrocytosis. J Neuroimmune Pharmacol 2016; 12:187-193. [PMID: 27826896 DOI: 10.1007/s11481-016-9717-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 10/28/2016] [Indexed: 11/26/2022]
Abstract
Blood brain barrier (BBB) damage is a common feature in central nervous system infections by HIV and it may persist despite effective antiretroviral therapy. Astrocyte involvement has not been studied in this setting. Patients were enrolled in an ongoing prospective study and subjects with central nervous system-affecting disorders were excluded. Patients were divided into two groups: treated subjects with cerebrospinal fluid (CSF) HIV RNA <50 copies/mL (CSF-controllers) and in late-presenters CD4+ T lymphocytes <100/uL. CSF biomarkers of neuronal or astrocyte damage were measured and compared to CSF serum-to-albumin ratio. 134 patients were included; 67 subjects in each group (50 %) with similar demographic characteristics (with the exception of older age in CSF controllers). CD4 (cells/uL), plasma and CSF HIV RNA (Log10 copies/mL) were 43 (20-96), 5.6 (5.2-6) and 3.9 (3.2-4.7) in LPs and 439 (245-615), <1.69 (9 patients <2.6) and <1.69 in CSFc. BBB impairment was observed in 17 late-presenters (25.4 %) and in 9 CSF-controllers (13.4 %). CSF biomarkers were similar but for higher CSF neopterin values in late-presenters (2.3 vs. 0.6 ng/mL, p < 0.001). CSARs were associated with CSF neopterin (rho = 0.31, p = 0.03) and HIV RNA (rho = 0.24, p = 0.05) in late-presenters and with CSF tau (rho = 0.51, p < 0.001), p-tau (rho = 0.47, p < 0.001) and S100beta (rho = 0.33, p = 0.009) in CSF-controllers. In HAART-treated subjects with suppressed CSF HIV RNA, BBB altered permeability was associated with markers of neuronal damage and astrocytosis. Additional treatment targeting astrocytosis and/or viral protein production might be needed in order to reduce HIV effects in the central nervous system.
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Affiliation(s)
- A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy.
| | - A Romito
- Laboratory of Immunology, Ospedale Maria Vittoria, ASL TO2, Torino, Italy
| | - C Atzori
- Unit of Neurology, Ospedale Maria Vittoria, ASL TO2, Torino, Italy
| | - V Ghisetti
- Laboratory of Microbiology and Molecular Biology, Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - C Cardellino
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - S Audagnotto
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - E Scarvaglieri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - F Lipani
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - D Imperiale
- Unit of Neurology, Ospedale Maria Vittoria, ASL TO2, Torino, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
| | - S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino at Ospedale Amedeo di Savoia, ASL TO2, Torino, Italy
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