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Taramasso L, De Vito A, Ricci ED, Orofino G, Squillace N, Menzaghi B, Molteni C, Gulminetti R, De Socio GV, Pellicanò GF, Sarchi E, Celesia BM, Calza L, Rusconi S, Valsecchi L, Martinelli CV, Cascio A, Maggi P, Vichi F, Angioni G, Guadagnino G, Cenderello G, Dentone C, Bandera A, Falasca K, Bonfanti P, Di Biagio A, Madeddu G, Bonfanti P, Di Biagio A, Ricci E, Sarchi E, Chichino G, Bolla C, Bellacosa C, Angarano G, Saracino A, Calza L, Menzaghi B, Farinazzo M, Angioni G, Bruno G, Celesia BM, Falasca K, Mastroianni A, Guadagnino G, Vichi F, Salomoni E, Martinelli C, Di Biagio A, Dentone C, Taramasso L, Bassetti M, Cenderello G, Molteni C, Piconi S, Pellicanò GF, Nunnari G, Valsecchi L, Cordier L, Parisini S, Rizzardini G, Rusconi S, Conti F, Bandera A, Gori A, Motta D, Puoti M, Bonfanti P, Squillace N, Migliorino GM, Maggi P, Martini S, Cascio A, Trizzino M, Gulminetti R, Pagnucco L, De Socio GV, Nofri M, Francisci D, Cibelli D, Parruti G, Madeddu G, Mameli MS, Orofino G, Guastavigna M. Durability of Dolutegravir-Based Regimens: A 5-Year Prospective Observational Study. AIDS Patient Care STDS 2021; 35:342-353. [PMID: 34524918 DOI: 10.1089/apc.2021.0089] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study evaluates the frequency and causes of dolutegravir (DTG) discontinuation along 5 years of follow-up, in both antiretroviral treatment (ART)-naive and experienced people living with HIV (PLWH). This is a prospective multi-center cohort study enrolling PLWH on DTG from July 2014 until November 2020. DTG-durability was investigated using the Kaplan-Meier survival curve. The Cox proportional-hazards model was used for estimating the hazard ratio (HR) of DTG discontinuation for any cause, and for adverse events (AEs). Nine hundred sixty-three PLWH were included, 25.3% were women and 28.0% were ART-naive. Discontinuations for any causes were 10.1 [95% confidence interval (95% CI) 8.9-11.5] per 100 person-years, similar in most regimens, with the apparent exception of tenofovir alafenamide/emtricitabine+DTG (p < 0.0001). In the multivariable Cox regression model, non-Caucasian ethnicity, age ≥50 years, and lower estimated glomerular filtration rate (eGFR) were associated with a higher probability of DTG interruption. The incidence rate of virological failure was 0.4 (95% CI 0.2-0.7) per 100 person-years, while the estimated discontinuation rate for AEs was 4.0 (3.2-4.9) per 100 person-years. Thirty-four DTG interruptions were due to grade ≥3 events (10 central nervous system, 6 hypersensitivity, 3 renal, 3 myalgia/asthenia, 3 abdominal pain, 2 gastrointestinal, and 7 other events). People with lower body mass index, age ≥50 years, and lower eGFR were at higher risk of AEs, while dual combinations were protective (HR 0.41 compared with abacavir/lamivudine/DTG, 95% CI 0.22-0.77). In this prospective observational study, we found high DTG durability and a low rate of virological failures. Dual therapies seemed protective toward AEs and might be considered, when feasible, a suitable option to minimize drug interactions and improve tolerability.
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Affiliation(s)
- Lucia Taramasso
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Andrea De Vito
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | - Giancarlo Orofino
- Unit of Infectious Diseases, “Divisione A”, Amedeo di Savoia Hospital, Torino, Italy
| | - Nicola Squillace
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Barbara Menzaghi
- Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio Hospital, Busto Arsizio, Italy
| | - Chiara Molteni
- Infectious Disease Unit, Ospedale A. Manzoni, Lecco, Italy
| | - Roberto Gulminetti
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giuseppe Vittorio De Socio
- Clinic of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giovanni Francesco Pellicanò
- Unit of Infectious Diseases, Department of Human Pathology of the Adult and the Developmental Age ‘G. Barresi’, University of Messina, Messina, Italy
| | - Eleonora Sarchi
- Infectious Diseases Unit, SS. Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | | | - Leonardo Calza
- Department of Medical and Surgical Sciences, Clinics of Infectious Diseases, S. Orsola-Malpighi Hospital, “Alma Mater Studiorum” University of Bologna, Bologna, Italy
| | - Stefano Rusconi
- Infectious Diseases Unit, Department of Biomedical and Clinical Sciences ‘Luigi Sacco’, Università degli Studi di Milano, Milan, Italy
| | - Laura Valsecchi
- Infectious Disease Unit (I Divisione), ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Paolo Maggi
- Department of Infectious Disease, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Francesca Vichi
- Infectious Diseases Department, SOC 1, USLCENTROFIRENZE, Santa Maria Annunziata Hospital, Florence, Italy
| | | | - Giuliana Guadagnino
- Department of Infectious and Tropical Diseases, St. Annunziata Hospital, Cosenza, Italy
| | | | - Chiara Dentone
- Infectious Disease Clinic, IRCCS Policlinico San Martino Hospital, Genoa, Italy
| | - Alessandra Bandera
- Infectious Disease Unit, Department of Internal Medicine, Fondazione IRCCS Ca’ Granda, University of Milan, Ospedale Maggiore Policlinico, Milan, Italy
| | - Katia Falasca
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University ‘G. d'Annunzio’ Chieti-Pescara, Chieti, Italy
| | - Paolo Bonfanti
- Infectious Diseases Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonio Di Biagio
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa, San Martino Hospital-IRCCS, Genoa, Italy
| | - Giordano Madeddu
- Unit of Infectious and Tropical Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Di Nisio M, Potere N, Candeloro M, Spacone A, Pieramati L, Ferrandu G, Rizzo G, La Vella M, Di Carlo S, Cibelli D, Parruti G, Levi M, Porreca E. Interleukin-6 receptor blockade with subcutaneous tocilizumab improves coagulation activity in patients with COVID-19. Eur J Intern Med 2021; 83:34-38. [PMID: 33162299 PMCID: PMC7608031 DOI: 10.1016/j.ejim.2020.10.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/16/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Many COVID-19 patients develop a hyperinflammatory response which activates blood coagulation and may contribute to the occurrence of thromboembolic complications. Blockade of interleukin-6, a key cytokine in COVID-19 pathogenesis, may improve the hypercoagulable state induced by inflammation. The aim of this study was to evaluate the effects of subcutaneous tocilizumab, a recombinant humanized monoclonal antibody against the interleukin-6 receptor on coagulation parameters. METHODS Hospitalized adult patients with laboratory-confirmed moderate to critical COVID-19 pneumonia and hyperinflammation, who received a single 324 mg subcutaneous dose of tocilizumab on top of standard of care were enrolled in this analysis. Coagulation parameters were measured before tocilizumab and at day 1, 3, and 7 after treatment. All patients were followed-up for 35 days after admission or until death. RESULTS 70 patients (mean age 60 years, interquartile range 52-75) were included. Treatment with tocilizumab was associated with a reduction in D-dimer levels (-56%; 95% confidence interval [CI], -68% to -44%), fibrinogen (-48%; 95%CI, -60% to -35%), C-reactive protein (-93%; 95%CI, -99% to -87%), prothrombin time (-4%; 95%CI,-9% to 0.8%), and activated thromboplastin time (-4%; 95%CI,-8.7% to 0.8%), and an increase in platelet count (34%; 95%CI, 23% to 45%). These changes occurred already one day after treatment with sustained reductions throughout day 7. The improvement in coagulation was consistently observed in patients receiving prophylactic or therapeutic dose anticoagulants, and was paralleled by a rapid improvement in respiratory function. CONCLUSIONS Subcutaneous tocilizumab was associated with significant improvement of blood coagulation parameters independently of thromboprophylaxis dose.
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Affiliation(s)
- Marcello Di Nisio
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy; Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
| | - Nicola Potere
- Department of Internal Medicine, "G. D'Annunzio" University, Chieti, Italy
| | - Matteo Candeloro
- Department of Medicine and Ageing Sciences, University G. D'Annunzio, Chieti-Pescara, Italy
| | | | - Leonardo Pieramati
- Department of Internal Medicine, "G. D'Annunzio" University, Chieti, Italy.
| | | | - Giulia Rizzo
- Department of Internal Medicine, "G. D'Annunzio" University, Chieti, Italy
| | - Matteo La Vella
- Department of Internal Medicine, "G. D'Annunzio" University, Chieti, Italy
| | - Silvio Di Carlo
- Geriatric Medicine Unit, Pescara General Hospital, Pescara, Italy.
| | | | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Marcel Levi
- Cardiometabolic Programme, National Institute for Health Research University College London Hospitals (UCLH) Biomedical Research Centre, Department of Medicine, UCLH National Health Service Foundation Trust, London NW1 2PG, UK.
| | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Chieti, Italy.
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Potere N, Di Nisio M, Cibelli D, Scurti R, Frattari A, Porreca E, Abbate A, Parruti G. Response to: 'Correspondence on 'Interleukin-6 blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: a case-control study' by Potere et al' by Buckley. Ann Rheum Dis 2020; 81:e195. [PMID: 32873552 DOI: 10.1136/annrheumdis-2020-218715] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Nicola Potere
- Department of Medical, Oral and Biotechnological Sciences, Università degli Studi Gabriele d'Annunzio, Chieti, Italy.,VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, Università degli Studi Gabriele d'Annunzio, Chieti-Pescara, Italy.,Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Rosa Scurti
- Geriatric Medicine Unit, Pescara General Hospital, Pescara, Italy
| | | | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, Università degli Studi Gabriele d'Annunzio, Chieti, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
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Potere N, Di Nisio M, Cibelli D, Scurti R, Frattari A, Porreca E, Abbate A, Parruti G. Response to: 'Rational use of tocilizumab in COVID-19' by Jain and Sharma. Ann Rheum Dis 2020; 81:e215. [PMID: 32737108 DOI: 10.1136/annrheumdis-2020-218626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Nicola Potere
- Department of Medical, Oral and Biotechnological Sciences, Università degli Studi Gabriele d'Annunzio, Chieti, Italy.,VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, Università degli Studi Gabriele d'Annunzio, Chieti-Pescara, Italy.,Department of Vascular Medicine, Amsterdam UMC Location AMC, Amsterdam, North Holland, Netherlands
| | | | - Rosa Scurti
- Geriatric Medicine Unit, Pescara General Hospital, Pescara, Italy
| | | | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, Università degli Studi Gabriele d'Annunzio, Chieti, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
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Potere N, Di Nisio M, Cibelli D, Scurti R, Frattari A, Porreca E, Abbate A, Parruti G. Interleukin-6 receptor blockade with subcutaneous tocilizumab in severe COVID-19 pneumonia and hyperinflammation: a case-control study. Ann Rheum Dis 2020; 80:1-2. [PMID: 32647027 DOI: 10.1136/annrheumdis-2020-218243] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Nicola Potere
- Department of Medical, Oral and Biotechnological Sciences, "G D'Annunzio" University, Chieti, Italy.,VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcello Di Nisio
- Department of Medicine and Ageing Sciences, "G' D'Annunzio" University, Chieti-Pescara, Italy.,Department of Vascular Medicine, Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | - Rosa Scurti
- Geriatric Medicine Unit, Pescara General Hospital, Pescara, Italy
| | | | - Ettore Porreca
- Department of Medical, Oral and Biotechnological Sciences, "G D'Annunzio" University, Chieti, Italy
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
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Frattari A, Savini V, Polilli E, Cibelli D, Talamazzi S, Bosco D, Consorte A, Fazii P, Parruti G. Ceftolozane-tazobactam and Fosfomycin for rescue treatment of otogenous meningitis caused by XDR Pseudomonas aeruginosa: Case report and review of the literature. IDCases 2018; 14:e00451. [PMID: 30263888 PMCID: PMC6156803 DOI: 10.1016/j.idcr.2018.e00451] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/29/2018] [Accepted: 08/29/2018] [Indexed: 11/18/2022] Open
Abstract
Infections due to XDR Pseudomonas are at increased risk of complications and death. CNS involvement may be due to poor CNS penetration of drugs with residual activity. XDR-PA meningitis ensued during treatment with colistin for pneumonia and bacteremia. CNS involvement by XDR-PA was timely suspected and quickly documented on CSF. High dose C-T and Fosfomycin provided rapid control of meningitis.
Extensively drug resistant Pseudomonas aeruginosa (XDR-PA) strains with limited or absent residual antimicrobial susceptibility cause a growing burden of difficult-to treat infections. Treatment options are even more limited for patients with central nervous system (CNS) involvement, as colistin-based regimens are hampered by poor blood brain barrier penetration, being often associated with insufficient clinical and microbiological success. New treatment options are awaited, but evidence from prospective evidence-based evaluations is still lacking. Here we report a case of breakthrough otogenous meningitis caused by XDR-PA in a young patient treated with meropenem and colistin for XDR-PA bloodstream infection and pneumonia after a car-crash polytrauma. The patient was treated with off-label, high-dose ceftolozane-tazobactam and high-dose fosfomycin after characterization of CNS XDR-PA isolates, with rapid clinical and microbiological resolution of meningitis. Our experience, although based on a single case, lands preliminary support to the concept that rescue regimens including ceftolozane-tazobactam and fosfomycin may be considered for XDR-PA CNS infections in patients without alternative therapeutic options.
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Affiliation(s)
| | - Vincenzo Savini
- Clinical Microbiology Unit, Pescara General Hospital, Pescara, Italy
| | - Ennio Polilli
- Clinical Pathology Laboratory, Pescara General Hospital, Pescara, Italy
| | | | | | - Donatella Bosco
- Intensive Care Unit, Pescara General Hospital, Pescara, Italy
| | - Augusta Consorte
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Paolo Fazii
- Clinical Microbiology Unit, Pescara General Hospital, Pescara, Italy
| | - Giustino Parruti
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
- Corresponding author at: Unit of Infectious Diseases, Pescara General Hospital, Via Fonte Romana 8, Pescara, Italy.
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Monno L, Brindicci G, Saracino A, Punzi G, Cibelli D, Lagioia A, Angarano G. V3 sequences and paired HIV isolates from 52 non-subtype B HIV type 1-infected patients. AIDS Res Hum Retroviruses 2010; 26:365-72. [PMID: 20334572 DOI: 10.1089/aid.2009.0224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Viral isolation and V3 sequencing were performed for 52 patients with non-subtype B viruses. The HIV-1 isolation rate was 93%, and 98% of isolates were characterized as NSI. V3 sequences corresponding to NSI isolates were compared to non-subtype B sequences with corresponding SI isolates from the Los Alamos database. The two sequence groups significantly differed in number of sequences with 35 amino acids, net charge, Brigg's coefficient, loss of NGS at positions 6-8, and 11/25 genotype (p < 0.0001). Substantial discrepancies in V3 variability were also observed. Basic amino acids at positions 8, 21, 23, and 24 were more frequent in SI sequences as were uncharged amino acids at positions 5, 6, 7, 8, 12, 13, 25, and 34. When characterizing paired viral isolates and V3 sequences from patients with non-subtype B HIV-1, current V3 sequence-based criteria from subtype B appeared to discriminate well between NSI and SI sequences from non-subtype B patients.
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Affiliation(s)
- Laura Monno
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | | | | | - Grazia Punzi
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
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Saracino A, Scotto G, Fornabaio C, Martinelli D, Faleo G, Cibelli D, Tartaglia A, Di Tullio R, Fazio V, Prato R, Monno L, Angarano G. QuantiFERON-TB Gold In-Tube test (QFT-GIT) for the screening of latent tuberculosis in recent immigrants to Italy. New Microbiol 2009; 32:369-376. [PMID: 20128443] [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: 05/28/2023]
Abstract
To evaluate the agreement between QuantiFERON-TB Gold In-Tube test (QFT-GIT) and tuberculin skin test (TST) for the screening of latent tuberculosis infection (LTBI) in recent immigrants to Italy, 279 subjects were submitted to concomitant TST and QFT-GIT. The agreement was analyzed using k statistics. A total of 72/279 (25.8%) individuals were TST positive, while 107/279 (38.3%) were QFT-GIT positive. The overall agreement between QFT-GIT and TST was 70.9%, with k statistic of 0.35. Using different TST and QFT-GIT cut-offs, the best concordance value was obtained for QFT-GIT at > 2.64 IU/ml and TST at > 10mm (k = 0.409). Discordant results were found for 58 subjects (21%) with QFT-GIT positive/TST negative and 23 (8%) with QFT-GIT negative/TST positive. A high amount of discordance QFT-GIT+/TST- was described. QFT-GIT might increase the identification of LTBI cases among recent immigrants.
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Saracino A, Scotto G, Palumbo E, Cibelli D, Tartaglia A, Armillotta M, Angarano G. Multiple recurrences of vertebral hydatidosis: a case report. New Microbiol 2005; 28:271-5. [PMID: 16240701] [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: 05/04/2023]
Abstract
We present a case of an Italian man with a particularly prolonged history of hydatid disease (more than 20 years, with six recurrences) involving both osseus (costal and vertebral) and visceral (pulmonary) sites. The main clinical problems involved in the diagnosis and management of vertebral manifestations of hydatidosis are discussed in the light of the latest clinical research.
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