The Database of European Forest Insect and Disease Disturbances: DEFID2

Insect and disease outbreaks in forests are biotic disturbances that can profoundly alter ecosystem dynamics. In many parts of the world, these disturbance regimes are intensifying as the climate changes and shifts the distribution of species and biomes. As a result, key forest ecosystem services, such as carbon sequestration, regulation of water flows, wood production, protection of soils, and the conservation of biodiversity, could be increasingly compromised. Despite the relevance of these detrimental effects, there are currently no spatially detailed databases that record insect and disease disturbances on forests at the pan-European scale. Here, we present the new Database of European Forest Insect and Disease Disturbances (DEFID2). It comprises over 650,000 harmonized georeferenced records, mapped as polygons or points, of insects and disease disturbances that occurred between 1963 and 2021 in European forests. The records currently span eight different countries and were acquired through diverse methods (e.g., ground surveys, remote sensing techniques). The records in DEFID2 are described by a set of qualitative attributes, including severity and patterns of damage symptoms, agents, host tree species, climate-driven trigger factors, silvicultural practices, and eventual sanitary interventions. They are further complemented with a satellite-based quantitative characterization of the affected forest areas based on Landsat Normalized Burn Ratio time series, and damage metrics derived from them using the LandTrendr spectral-temporal segmentation algorithm (including onset, duration, magnitude, and rate of the disturbance), and possible interactions with windthrow and wildfire events. The DEFID2 database is a novel resource for many large-scale applications dealing with biotic disturbances. It offers a unique contribution to design networks of experiments, improve our understanding of ecological processes underlying biotic forest disturbances, monitor their dynamics, and enhance their representation in land-climate models. Further data sharing is encouraged to extend and improve the DEFID2 database continuously. The database is freely available at https://jeodpp.jrc.ec.europa.eu/ftp/jrc-opendata/FOREST/DISTURBANCES/DEFID2/.

Effectiveness of field-exposed attract-and-kill devices against the adults of Popillia japonica (Coleoptera: Scarabaeidae): a study on duration, form and storage

BACKGROUND

The Japanese beetle Popillia japonica Newman is an insect pest native to Japan that has spread into North America, the Azores and, recently, into continental Europe. Here, we present a study assessing the effectiveness of a long-lasting insecticide-treated net (LLIN), assembled in semiochemical-baited attract-and-kill devices (A&Ks) as a low environmental impact means to control P. japonica in the field. We compared the attractiveness of three different forms of A&Ks that were left outdoors throughout the summer, and the residence time of P. japonica landing on them. Moreover, we performed a preliminary study testing the effectiveness of new LLINs after storage. Collected data also allowed us to investigate the beetles' diel flight patterns in relation to meteorological conditions.

RESULTS

Killing effectiveness of the field-exposed A&Ks declined steadily over the flight season (from 100% to 37.5%) associated with a decrease in residues of α-cypermethrin, the active ingredient in the LLINs. The different A&K forms (pyramidal, octahedral and ellipsoidal) attracted similar numbers of beetles. Individual beetles' residence time ranged from 75 to 95 s and differed slightly between A&K forms. Effectiveness of LLINs decreased by ≈30% after 1 year storage. Based on numbers landing on A&Ks, the beetles' flight activity peaked about 14:30 h and was inversely correlated with relative humidity.

CONCLUSION

This study indicates that semiochemical-baited A&Ks are effective for controlling P. japonica in the field. Because of active ingredient decay, the LLINs should be replaced after 30-40 days of field exposure to ensure that the A&Ks remain fully functional. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Popillia japonica - Italian outbreak management

Popillia japonica, a priority pest for the EU, was first detected in Northern Italy in 2014. Since its discovery, the outbreak extended over an area of more than 16,000 square kilometers in Northern Italy and Southern Switzerland. In this review, we summarize the state-of-the-art of research conducted in Italy on both the spreading capacity and control measures of P. japonica. Chemical, physical, and biological control measures deployed since its detection are presented, by highlighting their strengths and weaknesses. An in-depth study of the ecosystems invaded by P. japonica disclosed the presence and pathogenicity of natural strains of entomopathogenic fungi and nematodes, some of which have shown to be particularly aggressive towards the larvae of this pest under laboratory conditions. The Plant Health authorities of the Lombardy and Piedmont regions, with the support of several research institutions, played a crucial role in the initial eradication attempt and subsequently in containing the spread of P. japonica. Control measures were performed in the infested area to suppress adult populations of P. japonica by installing several traps (e.g., for mass trapping, for auto-dissemination of the fungus Metarhizium anisopliae, and "attract & kill"). For larval control, the infested fields were treated with commercial strains of the entomopathogenic fungus M. anisopliae and nematode Heterorhabditis bacteriophora. Future studies will aim at integrating phenological and spread models developed with the most effective control measures, within an ecologically sustainable approach.

Genetic variability of Metarhizium isolates from the Ticino Valley Natural Park (Northern Italy) as a possible microbiological resource for the management of Popillia japonica

The natural occurrence of entomopathogenic fungi (EPF) was investigated along the Ticino River (Ticino River Natural Park, Novara Province, Piedmont, Italy), at the center of the area of the first settlement of the invasive alien pest Popillia japonica. Using Zimmermann's "Galleria bait method", EPF were successfully isolated from 83 out of 155 soil samples from different habitats (perennial, cultivated, or uncultivated meadows, woodlands, and riverbanks). Sequencing of the 5' end of the Translation Elongation Factor 1 alfa (5'-TEF) region allowed the assignment of 94% of the isolates to Metarhizium spp., while 8% and 7% were assigned to Beauveria spp. and Paecilomyces spp., respectively. Four Metarhizium species were identified: Metarhizium robertsii was the most common one (61.5% of the isolates), followed by M. brunneum (24.4%), M. lepidiotae (9%), and M. guizhouense (5.1%). Microsatellite marker analysis of the Metarhizium isolates revealed the presence of 27 different genotypes, i.e., 10 genotypes among M. robertsii, 8 among M. brunneum, 5 among M. lepidiotae, and 4 among M. guizhouense. Metarhizium brunneum appeared to be associated with woodlands and more acid soils, while the other species showed no clear association with a particular habitat. Laboratory virulence tests against P. japonica 3rd instar larvae allowed the identification of one M. robertsii isolate that showed efficacy as high as 80.3%. The importance of this kind of study in the frame of eco-friendly microbiological control is discussed.

Rearing Trissolcus japonicus and Trissolcus mitsukurii for Biological Control of Halyomorpha halys

Halyomorpha halys is a severe agricultural pest of Asian origin that has invaded many countries throughout the world. Pesticides are currently the favored control methods, but as a consequence of their frequent use, often disrupt Integrated Pest Management. Biological control with egg parasitoids is seen as the most promising control method over the long-term. Knowledge of the reproductive biology under laboratory conditions of the most effective candidates (Trissolcus japonicus and Trissolcus mitsukurii) for optimizing production for field releases is strongly needed. Rearing of these egg parasitoids was tested by offering three different host supply regimes using new emerged females and aged, host-deprived females in different combinations. Results showed a mean progeny per female ranging from 80 to 85 specimens for T. japonicus and from 63 to 83 for T. mitsukurii. Sex ratios were strongly female biased in all combinations and emergence rates exceeded 94% overall. Cumulative curves showed that longer parasitization periods beyond 10-14 days (under the adopted rearing regimes) will not lead to a significantly increase in progeny production. However, ageing females accumulate eggs in their ovaries that can be quickly laid if a sufficient number of host eggs are supplied, thus optimizing host resources. Our data showed that offering H. halys egg masses to host-deprived female Trissolcus once a week for three weeks allowed its eggs to accumulate in the ovary, providing the greatest number of offspring within a three week span.

Scent of Jasmine Attracts Alien Invaders and Records on Citizen Science Platforms: Multiple Introductions of the Invasive Lacebug Corythauma ayyari (Drake, 1933) (Heteroptera: Tingidae) in Italy and the Mediterranean Basin

The jasmine lacebug Corythauma ayyari is a pest of cultivated and ornamental plants mainly associated to Jasminum spp. This invasive insect is native to Asia, and it has been recently introduced in several countries, mainly within the Mediterranean basin. Here, we updated the known distribution of this species, including five new Italian regions (Liguria, Tuscany, Latium, Apulia, and Calabria); Salamis Island in Greece, and the Occitanie region in France. Citizen-science data have significantly contributed to the knowledge on species distribution, and the online platform for sharing biodiversity information can represent an effective tool for the early detection. Molecular analyses revealed that the specimens collected in Peninsular Italy and Sicily belong to a unique clade, suggesting the possibility of a single introduction, whereas those from Menton (France) and Calabria (Southern Italy) are separated from the others and probably originate from separated introductions.

Assessment of color response and activity rhythms of the invasive black planthopper Ricania speculum (Walker, 1851) using sticky traps

To be effective, management strategies of invasive alien species cannot ignore their spatiotemporal behavior particularly those exerting serious damages to human activities. The black planthopper Ricania speculum is an Asian insect that has been reported as an alien invasive species in Italy, where it threatens local plant diversity, including important crops. In our work, we analyzed the activity rhythms of this species through circular statistics and the efficiency of chromotropic traps to capture adult individuals. Captures were carried out in central Italy, where the black planthopper is showing a remarkable range expansion, after its first discovery in 2009. We observed that the species was mainly crepuscular, with a high intersexual activity overlap. Activity rhythms changed between July-August and September-October, with changing heliophany, but peaked at sunset and were the lowest in the second half of the night and early morning. The insects were mostly caught by green traps, particularly in September, which is the period of egg-laying inside the leaves; conversely, orange ones were avoided, and yellow ones captured proportionally to their local availability. Strategies for controlling this species should consider concentrating trapping effort during the activity peak, using green sticky traps to enhance the capture success of each trap, with the lowest impact over non-target species.

Sperm ultrastructure and spermatogenesis in the Japanese beetle Popillia japonica (Coleoptera, Scarabaeidae)

Popillia japonica is an invasive scarab beetle native to Japan that in 1916 invaded New Jersey in USA. From that moment onwards, the insect has spread invading several US states, Canada, the Azores, Italy and, recently, Switzerland. It is a severe agricultural pest included in the EU priority pest list being able to feed on more than 300 plant species and having an important biotic potential. The general morphology of the reproductive apparatus shows paired testes, each of them having six testicular lobes grouped in threes. From the ventral part of each testicular lobe, each containing about 20 follicles, an efferent vessel originates that fuses with the other efferent vessels to form the deferent duct. A pair of long tubular accessory glands is present. The deferent ducts and accessory glands fuse together into an ejaculatory duct before entering the aedeagus. The sperm is a typical pterygote sperm, 110 μm long, composed of a head and a tail. In the head a three-layered acrosome of about 6 μm in length and a nucleus of about 18 μm long are present. During sperm maturation two C-shaped structures appear in the cytoplasm from the opposite sides of the nucleus that then disappear in late spermatids. In the tail a typical 9 + 9 + 2 flagellar axoneme and two mitochondrial derivatives are present. Moreover, in the head-tail transition region the centriolar adjunct forms a sheath from which three elongated accessory bodies originate. Two of these accessory bodies are placed alongside the axoneme, whilst the third one is placed beneath the mitochondrial derivatives. Mature sperm are grouped in cysts containing about 256 sperm cells. A morphological comparison with related species is provided.

First report of Bursaphelenchus fungivorus (Nematoda: Aphelenchida) in Italy and an overview of nematodes associated with Crocus sativus L

Saffron is one of the most precious spices in the world. It is derived from the dried stigmas of the Crocus sativus L. flowers. This plant is triploid sterile and propagated by corms. As a subterranean organ, the corm can come into contact with different nematodes. In this contribution Bursaphelenchus fungivorus was reported for the first time in Italy. It was found associated with C. sativus corms and characterized based on morphological and morphometrical characteristics for this species. The identification was confirmed using molecular analyses. Moreover, a review of nematodes associated with C. sativus worldwide is also provided.

Developmental stages and gut microenvironments influence gut microbiota dynamics in the invasive beetle Popillia japonica Newman (Coleoptera: Scarabaeidae)

Popillia japonica Newman (Coleoptera: Scarabaeidae) is a highly polyphagous invasive beetle originating from Japan. This insect is highly resilient and able to rapidly adapt to new vegetation. Insect-associated microorganisms can play important roles in insect physiology, helping their hosts to adapt to changing conditions and potentially contributing to an insect's invasive potential. Such symbiotic bacteria can be part of a core microbiota that is stably transmitted throughout the host's life cycle or selectively recruited from the environment at each developmental stage. The aim of this study was to investigate the origin, stability and turnover of the bacterial communities associated with an invasive population of P. japonica from Italy. Our results demonstrate that soil microbes represent an important source of gut bacteria for P. japonica larvae, but as the insect develops, its gut microbiota richness and diversity decreased substantially, paralleled by changes in community composition. Notably, only 16.75% of the soil bacteria present in larvae are maintained until the adult stage. We further identified the micro-environments of different gut sections as an important factor shaping microbiota composition in this species, likely due to differences in pH, oxygen availability and redox potential. In addition, P. japonica also harboured a stable bacterial community across all developmental stages, consisting of taxa well known for the degradation of plant material, namely the families Ruminococcacae, Christensenellaceae and Lachnospiraceae. Interestingly, the family Christensenallaceae had so far been observed exclusively in humans. However, the Christensenellaceae operational taxonomic units found in P. japonica belong to different taxonomic clades within this family.

Long-lasting insecticide-treated nets: A new integrated pest management approach for Popillia japonica (Coleoptera: Scarabaeidae)

The Japanese beetle Popillia japonica Newman is a US and EU quarantine insect pest that has recently invaded northern Italy. Its ability to rapidly spread in new areas makes this insect a threat to agriculture. In the last decades, several trials on biological control of the Japanese beetle by entomopathogenic nematodes and fungi have been carried out with variable efficacy. However, the necessity of an integrated pest management approach to improve control has arisen. Long-lasting insecticide-treated nets (LLINs) have been used to control other agricultural pests with an attract-and-kill strategy. Here, we present results from laboratory evaluation of 2 LLINs, Storanet® (BASF™) and ZeroFly® (Vestergaard™), against P. japonica adults. Both were effective in killing the beetles; however, some differences emerged if different exposure times were compared: ZeroFly® always gave 100% mortality in tests from 5-s to 30-min exposure; Storanet® showed 100% mortality only with 30-min exposure and going down to 89%-99% mortality for 5-s to 15-min exposure. A description of the paralysis process occurring at 5-s exposure is given. Possible field application of LLINs within programs of integrated pest management is discussed. Integr Environ Assess Manag 2019;15:259-265. © 2018 SETAC.

Description of Bursaphelenchus irokophilus n. sp. (Nematoda: Aphelenchoididae) isolated from Milicia excelsa (Welw.) C.C. Berg wood imported into Italy from Cameroon

A new species of Bursaphelenchus, extracted from unprocessed logs of Milicia excelsa from Cameroon and arriving in the port of Leghorn, Tuscany, Central Italy, is described. Bursaphelenchus irokophilus n. sp. is based upon morphological and molecular characters and is characterised by the two-lined lateral field, mitten-shaped spicule possessing cucullus and well-developed and slightly dorsally curved condylus with narrowly rounded tip, female vulva with side flap, and long, smoothly tapering and strongly ventrally recurved female tail. The new species belongs to the abietinus-group and is similar to, but distinguished from, B. abietinus and B. rainulfi by the position of secretory-excretory pore, longer and slender female tail and some morphometric values. In addition, the phylogeny based on SSU and D2-D3 LSU regions shows that this species belongs to the abietinus-group, the relationship among the species of this group being discussed.

Adaptive management of invasive pests in natural protected areas: the case of Matsucoccus feytaudi in Central Italy

Invasive species are a significant threat to affected ecosystems, having serious environmental, economic and social impacts. The maritime pine bast scale, Matsucoccus feytaudi Ducasse (Hemiptera: Matsucoccidae), causes serious damage to Pinus pinaster forests in SE France, Corsica and Italy where it has been introduced. This study illustrates the adaptive management plan implemented in the Migliarino, San Rossore, Massaciuccoli Regional Natural Park in Tuscany, Italy, where M. feytaudi arrived in 2004, leading to the decay of local P. pinaster stands. The management programme, aimed at slowing the establishment and growth of M. feytaudi, was carried out in the main sector of the park, Tenuta di San Rossore, to retard the destruction of the P. pinaster coastal strip protecting the more internal woodland from sea salt and to allow replacement of P. pinaster trees with a more stable broad-leaved wood. The combined use of mass trapping and silvicultural interventions, applied in a targeted manner according to distribution maps of pest captures and damage, helped to delay forest destruction compared with a nearby unmanaged area of the park Tenuta di Tombolo. Although M. feytaudi continued to spread during the management period, the populations remained at low levels for 6 years, showing a marked increase in 2012. During this period, the P. pinaster stands were reduced from 320 to 249 ha. The final result of this ongoing gradual conversion process will be transformation of the P. pinaster forest into Holm oak woods and Mediterranean shrub land, while P. pinaster will survive as clusters or blocks of trees.

Birth weight for gestational age centiles for Italian neonates

OBJECTIVE

To provide centiles for birth weight (BW) according to gestational age (GA) and sex for infants born in Italy.

METHODS

We used records of the whole neonatal population of Tuscany, a region in Italy, from July 1991 to June 2002 as resulting from the database of the cystic fibrosis neonatal screening program (n=290129). We excluded as unlikely for GA those BW that were more than two interquartile ranges above the 75th centile or below the 25th centile for each GA and gender group.

RESULTS

We present the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles of BW for GA from the 24th to 43rd week of gestation for male and female Italian neonates, as both tables and smoothed curves.

CONCLUSIONS

The large size of the examined population allows us to provide up-to-date, reliable BW for GA centiles for Italian newborns, especially for lower GAs.

First Report of Botryosphaeria dothidea on Sycamore, Red Oak, and English Oak in Northwestern Italy

The Parco Nord Milano, Italy is a 600-ha green area (45°53'71″N, 9°20'97″E). Since the spring of 2002, extensive and unknown decline was observed on 20-year-old sycamore (Acer pseudoplatanus), red oak (Quercus rubra), and English oak (Q. robur) plantations. The trees showed branch and twig dieback associated with bark cankering along the whole stem and an irregular to wilted crown. A closer inspection of the inner part of the symptomatic trunk and roots revealed a dark bluish tissue discoloration. From the symptomatic trunk and root tissue, a dark gray abundant mycelium was consistently isolated on potato dextrose agar (PDA). The sequenced internal transcribed spacer (ITS) regions of rDNA (GenBank Accession Nos. DQ198265, DQ198266, and DQ198267) showed 99% identity to Botryosphaeria dothidea strain CBS110302 (GenBank Accession No. AY259092). A Fusicoccum sp. with black pycnidia was consistently collected from the cankers. The conidia were hyaline, aseptate, fusiform to narrowly ellipsoidal, with a truncate base (22 × 4.5 μm), referred to as Fusicoccum aesculi (CBS identification), the anamorph of B. dothidea (2). Pathogenicity tests were conducted for all three hosts by stem inoculation on 18-month-old seedlings growing in plastic pots containing a 2:1 turf/sand mixture. Two experiments were conducted using two inoculation techniques. In the first trial, 6-mm-diameter mycelial plugs of B. dothidea were applied to 6-mm-long bark wounds. The same inoculation method was used for application to bark without wounding. Control seedlings were inoculated with sterile agar plugs in a similar fashion as above. Inoculated and control seedlings were kept in a growth chamber and watered once per week. In the second trial, segments of branches 15-cm long were inoculated with 6-mm-diameter B. dothidea plugs (1), with and without any wounding. Control segments of branches were treated with sterile agar plugs in place of fungal mycelium. The branches were incubated at 23°C in moist chambers. For both experiments, the inoculated stem portions were wrapped with Parafilm to prevent desiccation. There were three replicate seedlings per inoculation technique, experiment, and plant species. After 2 months, all seedlings showed bark cankers and pycnidial formation, while the controls were symptomless. An inner dark bluish stem tissue discoloration was observed. The symptoms were more abundant on the segment of branches where the inoculum was applied to the wounded bark. B. dothidea was successfully reisolated, confirming Koch's postulates. To our knowledge, although it is accepted as synonymous of B. berengeriana (2), this is the first report of B. dothidea on sycamore, red oak, and English oak in Italy. The fungus was previously reported in Italy to cause canker on Platanus spp. References: (1) M. E. Sanchez et al. Plant Dis. 87:1515, 2003. (2) B. Slippers et al. Mycologia 96:83, 2004.

Allergic bronchopulmonary aspergillosis in Italian cystic fibrosis patients: prevalence and percentage of positive tests in the employed diagnostic criteria

The prevalence of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is difficult to determine because the data in the literature are not homogeneous or comparable. ABPA and CF have similar clinical symptoms which make diagnosis difficult and underestimate the real dimensions of the problem. We conducted an epidemiological study on 3089 Italian CF patients to determine the prevalence of ABPA in Italy and verify the percentage of positive tests in the employed diagnostic criteria. Our results indicate that the prevalence of ABPA in Italian CF patients is 6.18%, mainly in adolescents and young adults. ABPA is diagnosed using clinical symptoms (presence of episodic bronchial obstructions or typical radiographic features) and on the basis of other criteria which can only be partially fulfilled in paediatric patients. Among the diagnostic tests the most sensitive are the total IgE (84.5%), specific IgE anti-Aspergillus fumigatus (81.6%) and the prick test (68.3%). In the absence of clinical symptoms and gold standard diagnostic tests, serological positivity and/or the skin test are not sufficient evidence to confirm the presence of ABPA.

[Anti-Pseudomonas aeruginosa antibodies, circulating immune complexes, and anticytoplasm antibodies of neutrophils in patients with cystic fibrosis with and without Pseudomonas aeruginosa colonization]

Chronic lung infections, mainly due to Pseudomonas aeruginosa (Pa), account for the most of the morbidity and mortality in CF patients. The pathogenic factors predisposing to airway colonization are still nuclear. Host's immune response is not only poorly protective but can also act as a damaging factor in the development of the disease. Moreover, clinical manifestations of an overactive immune response, including vasculitis and arthropathy, have been recently described in the CF population. To deepen factors involved in the pathogenesis of lung injury, we evaluated the presence of anti-Pa precipitating antibodies, circulating immune complexes (CIC) and antineutrophil cytoplasmic antibodies (ANCA) in sera from 50 CF patients colonized and not by Pa. Number of anti-Pa precipitins was significantly different in chronically and in not colonized patients (p < 0.001; t = 7.75). Anti-Pa antibodies were positively correlated to age (p = 0.002, r = 0.42) and inversely correlated to lung function parameters (p = 0.031 r = -0.35 with respect to FVC). Mean C3-CIC levels in the sera were statistically higher in chronically colonized patients (p = 0.013; t = 2.57); while there was not a significant difference with respect to C1q-CIC values. Four patients, all chronically colonized by Pa, were ANCA-positive at indirect immunofluorescence, showing a cytoplasmic pattern. All 50 patients were found to be negative when tested for anti-mpo and anti-pr3 antibodies with ELISA. In conclusion, our data demonstrate that persistence of Pa provides a stimulus for chronic inflammation and the immune response in CF patients, leading to anti-Pa antibodies and CIC production. Even in the face of further research, we speculate that c-ANCA production is secondary to neutrophil activation with a consequent release of cytoplasmic enzymes that perpetuate and increase the inflammatory process. Since anti-mpo and anti-pr3 antibodies rarely occur in CF patients we suggest that other antigenic specificities may be involved in ANCA production.

Evaluation of glucose tolerance and insulin secretion in cystic fibrosis patients

Blood glucose profile and insulin levels during the oral glucose tolerance test were retrospectively analyzed in 52 cystic fibrosis (CF) patients aged 10-33 years (mean 18 years). Thirty-seven subjects (71.1%) had normal glucose tolerance; 6 patients (11.5%) had impaired glucose tolerance and 9 patients (17.3%), with fasting blood glucose levels below 7.2 mmol/l were classified as diabetic, according to WHO diagnostic criteria. No significant differences in the total amount of secreted insulin (expressed as area under the curve) were detected in CF patients with or without glucose intolerance, but a significant delay in the insulin peak time appeared to be related to a compromised nutritional status. Our data indicate a significantly increased risk of glucose metabolism impairment related to poor nutritional condition (RR 5.40; 95% CI: 1.5-19.7) and worse clinical status (RR 4.27; 95% CI: 1.05-17.2). In particular, glucose tolerance abnormalities were found in 50% of CF patients with an unsatisfactory nutritional condition versus 15.6% of CF patients with good nutritional status.

CONCLUSIONS

Since CF-related diabetes is often underdiagnosed and associated with deterioration in patients' overall clinical status, it is very important to identify subjects at risk of developing diabetes by strict monitoring of glucose metabolism when deterioration in nutritional and clinical conditions is seen which cannot be otherwise explained.

[Bacterial infections and resistance to antibiotics in cystic fibrosis]

Knowledge of the microbiology of pulmonary infections is critical for treatment of cystic fibrosis because sickness and mortality in this disease are mainly due to relapse occurring in the respiratory tract. The microbiology of pulmonary infections presents several singular aspects. Respiratory tract infections are caused by bacteria such as Staphylococcus aureus in the early years of life and Pseudomonas aeruginosa and Burkholderia cepacia thereafter. The patients, who are not immune compromised, are predisposed to chronic colonization and highly transmissible bacterial strains can cause cross-infections. Bacterial also develop resistance mechanisms which make them difficult to treat. Until recently the relationship between genetic defects and a predisposition to colonization was not noted, but recent studies have allowed us to form some interesting hypothesis. The present work analyzes the principal mechanisms of antibiotic resistance, with particular reference to classic cystic fibrosis pathogens, and looks at future prospects of respiratory tract infection treatment.

Multiresistant non-fermentative gram-negative bacteria in cystic fibrosis patients: the results of an Italian multicenter study. Italian Group for Cystic Fibrosis microbiology

We carried out an epidemiological study on 2717 patients seen on a regular basis at Italian Cystic Fibrosis Centers with the aim of defining the prevalence of multiresistant Gram-negative strains in Italy. We found 272 multiresistant strains out of 1560 Gram-negative strains isolated in 1012 Italian cystic fibrosis patients. From our results in Italian cystic fibrosis patients we may conclude: (1) the beta-lactam antibiotics are moderately active; ceftazidime is the most efficacious even if 59.9% of multiresistant strains are not sensitive to this drug; (2) the aminoglycosides are poorly efficacious; 93% of multiresistant strains are resistant in vitro to tobramycin; and (3) the quinolones, notwithstanding their relatively recent introduction into clinical practice, have very poor activity against multiresistant strains, 89.7% of which are not sensitive.

Genetic history of cystic fibrosis mutations in Italy. I. Regional distribution

Earlier analysis of the Italian population showed patterns of genetic differentiation that were interpreted as being the result of population settlements going back to pre-Roman times. DNA disease mutations may be a powerful tool in further testing this hypothesis since the analysis of diseased individuals can detect variants too rare to be resolved in normal individuals. We present data on the relative frequencies of 60 cystic fibrosis (CF) mutations in Italy and the geographical distribution of the 12 most frequent CF mutations screened in 3492 CF chromosomes originating in 13 Italian regions. The 12 most frequent mutations characterize about 73% of the Italian CF chromosomes. The most common mutation, delta F508, has an average frequency of 51%, followed by N1303K and G542X, both with average frequencies around 5%. Multivariate analyses show that the relative frequencies of CF mutations are heterogeneous among Italian regions, and that this heterogeneity is weakly correlated with the geographical pattern of non-DNA 'classical' genetic markers. The northern regions are well differentiated from the central-southern regions and within the former group the western and eastern regions are remarkably distinct. Moreover, Sardinia shows the presence of mutation T338I, which seems absent in any other European CF chromosome. The north-western regions of Italy, characterized by the mutation 1717-1G-->A, were under Celtic influence, while the north-east regions, characterized by the mutations R1162X, 2183AA-->G and 711 + 5G-->A, were under the influence of the Venetic culture.

[Pseudomonas aeruginosa antibodies in patients with cystic fibrosis: clinical implications]

Patients chronically colonised by P. aeruginosa develop a pronounced antibody response against P. aeruginosa that can be used to discriminate between superficial colonization and chronic infection. Anti-P. aeruginosa antibodies fail to afford protection against this pathogen; moreover high levels of antibodies are correlated with a poor prognosis. We investigated the significance of anti-P. aeruginosa antibodies (precipitins) by crossed immunoelectrophoresis (CIE) in 94 patients attending the Cystic Fibrosis Center of Florence. The highest numbers of precipitins were found in serum from patients chronically colonized in comparison to those patients who were transiently or not colonized. A negative correlation was found between the number of precipitin peaks and clinical conditions, evaluated with Schwachman score, and the number of precipitins and pulmonary functions. In summary, anti-P. aeruginosa antibodies fail to protect against P. aeruginosa bronchopulmonary infections, and are correlated to a more severe disease. Based on our experience, P. aeruginosa antibodies can be considered a reliable index of lung damage.

[Azlocillin in the treatment of pulmonary infections in patients with cystic fibrosis: plasma concentrations and therapeutic indications]

Azlocillin plasma concentrations have been studied in 10 cystic fibrosis patients suffering from chronic pulmonary infections with Pseudomonas aeruginosa. Patients were given single i.v. doses of 100 e 200 mg/kg body weight as intravenous infusion over 30 minutes. Azlocillin plasma levels have been assayed by a rapid, sensitive and precise high performance liquid chromatographic method. After the dose of 100 mg/kg body weight concentrations of azlocillin decreased below the therapeutic concentrations after three hours; dose of 200 mg/kg was followed by plasma concentrations in the therapeutically desirable range during the 6-8 hours study period. The pharmacokinetic analysis offers further evidence of the dose-dependent nature of azlocillin elimination. Higher dosage of 200 mg/kg body weight and monitoring of plasma drug levels are recommended in the therapy of patients with cystic fibrosis.

[Experience acquired over a 4-year period with the Vichi method in the study of bronchopulmonary changes in cystic fibrosis]

The classification of chest alterations in Cystic Fibrosis (CF) and related score proposed by Chrispin and Norman has been widely adopted in Europe and is still applied (although slightly modified) in most European Centres. Brasfield classification instead has been mostly used in the USA. Lately, however, to revise both classifications, the need has been felt, for a more precise correlation to anatomo-radiological data as well as for inclusion of headings which have not been taken into account so far. In 1980 one of the Authors (Vichi) worked out a new scoring system for the chest alterations of CF. Results are reported from a follow-up of 15 patients with CF carried out at the FC Centre of Meyer Ospedale in Florence from the late 1981 to 1985. The patients underwent periodic checkings including determination of clinical scoring system-according to Shwachman and Kulczychi modified by Doershuk-respiratory function tests, chest X-rays evaluated by three radiologists separately, following both Chrispin and Norman and Vichi scoring systems. The latter system has proved to be well correlated to clinical data and to the ordinary pulmonary function tests but it mainly presents a high observer reproducibility.

[Pharmacokinetics of oral theophylline. Comparison between asthmatic and cystic fibrosis patients]

The pharmacokinetics of oral theophylline at steady-state were comparatively investigated in 13 asthmatic patients and in 10 patients with cystic fibrosis (CF). In all patients, the drug was administered twice daily as slow-release tablets. The total daily dose of theophylline ranged from 10.8 to 29.4 mg/kg/day. For each patient, the time-course of theophylline steady-state plasma levels was studied after the morning dose. Six serial plasma samples were drawn at 0, 2, 4, 6, 8, and 12 h after dosing. Model-independent methods were used for calculating the pharmacokinetics parameters (area under the curve and clearance). The clearance values (mean +/- SD) calculated in the two patient groups were significantly different (asthmatic patients: clearance = 61.2 +/- 15.6 ml/h/kg; CF patients: clearance = 86.3 +/- 22.8 ml/h/kg; P = 0.007). It has previously been shown that the clearance of theophylline after single dose is increased in CF patients. Our study confirms this finding under steady-state conditions and demonstrates that higher theophylline doses are on the average required to treat patients with FC.

[Our experience with antibiotic therapy in children hospitalized between 1979 and 1981]

The use of antibiotics in the Children Hospital of Florence has been studied considering the whole hospital for 1979 and only one department for 1980-81. 7832 clinical records of children admitted to the Hospital have been analyzed in order to get more informations about the quality of antibiotic treatment and to understand the causes of use and misuse of this kind of drugs in pediatric practice.

[Vaccines and anti-rubella immunity (author's transl)]

The teratogenic effect of maternal rubella virus infection upon the offspring is well established. The present article deals with the problem of susceptibility to rubella infection among women in prepubertal and postpubertal age. The sieropositivity values in female populations from different italian areas are reported. The different types of vaccines for rubella and the preparation techniques are reviewed, and the immunity either induced by natural virus infection or acquired through vaccination is discussed. The conclusion is drawn that it is useful to offer rubella vaccine to girls and that, as far as it is known at present, the vaccine RA 27/3 is the most reliable.