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Ng CKY, Di Costanzo GG, Tosti N, Paradiso V, Coto-Llerena M, Roscigno G, Perrina V, Quintavalle C, Boldanova T, Wieland S, Marino-Marsilia G, Lanzafame M, Quagliata L, Condorelli G, Matter MS, Tortora R, Heim MH, Terracciano LM, Piscuoglio S. Genetic profiling using plasma-derived cell-free DNA in therapy-naïve hepatocellular carcinoma patients: a pilot study. Ann Oncol 2019; 29:1286-1291. [PMID: 29509837 DOI: 10.1093/annonc/mdy083] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Hepatocellular carcinomas (HCCs) are not routinely biopsied, resulting in a lack of tumor materials for molecular profiling. Here we sought to determine whether plasma-derived cell-free DNA (cfDNA) captures the genetic alterations of HCC in patients who have not undergone systemic therapy. Patients and methods Frozen biopsies from the primary tumor and plasma were synchronously collected from 30 prospectively recruited, systemic treatment-naïve HCC patients. Deep sequencing of the DNA from the biopsies, plasma-derived cfDNA and matched germline was carried out using a panel targeting 46 coding and non-coding genes frequently altered in HCCs. Results In 26/30 patients, at least one somatic mutation was detected in biopsy and/or cfDNA. Somatic mutations in HCC-associated genes were present in the cfDNA of 63% (19/30) of the patients and could be detected 'de novo' without prior knowledge of the mutations present in the biopsy in 27% (8/30) of the patients. Mutational load and the variant allele fraction of the mutations detected in the cfDNA positively correlated with tumor size and Edmondson grade. Crucially, among the seven patients in whom the largest tumor was ≥5 cm or was associated with metastasis, at least one mutation was detected 'de novo' in the cfDNA of 86% (6/7) of the cases. In these patients, cfDNA and tumor DNA captured 87% (80/92) and 95% (87/92) of the mutations, suggesting that cfDNA and tumor DNA captured similar proportions of somatic mutations. Conclusion In patients with high disease burden, the use of cfDNA for genetic profiling when biopsy is unavailable may be feasible. Our results support further investigations into the clinical utility of cfDNA in a larger cohort of patients.
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Affiliation(s)
- C K Y Ng
- Institute of Pathology, University Hospital Basel, Basel; Hepatology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland.
| | - G G Di Costanzo
- Department of Transplantation - Liver Unit, Cardarelli Hospital, Naples
| | - N Tosti
- Institute of Pathology, University Hospital Basel, Basel
| | - V Paradiso
- Institute of Pathology, University Hospital Basel, Basel
| | - M Coto-Llerena
- Hepatology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - G Roscigno
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University of Naples, Naples, Italy
| | - V Perrina
- Institute of Pathology, University Hospital Basel, Basel
| | - C Quintavalle
- Institute of Pathology, University Hospital Basel, Basel
| | - T Boldanova
- Hepatology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
| | - S Wieland
- Hepatology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland
| | | | - M Lanzafame
- Institute of Pathology, University Hospital Basel, Basel
| | - L Quagliata
- Institute of Pathology, University Hospital Basel, Basel
| | - G Condorelli
- Department of Molecular Medicine and Medical Biotechnology, "Federico II" University of Naples, Naples, Italy
| | - M S Matter
- Institute of Pathology, University Hospital Basel, Basel
| | - R Tortora
- Department of Transplantation - Liver Unit, Cardarelli Hospital, Naples
| | - M H Heim
- Hepatology Laboratory, Department of Biomedicine, University of Basel, Basel, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Basel, Basel, Switzerland
| | | | - S Piscuoglio
- Institute of Pathology, University Hospital Basel, Basel.
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Cappabianca G, Paparella D, D’Onofrio A, Caprili L, Minniti G, Lanzafame M, Parolari A, Musumeci F, Beghi C. OC46 MYCOBACTERIUM CHIMAERA INFECTIONS FOLLOWING CARDIAC SURGERY IN ITALY. J Cardiovasc Med (Hagerstown) 2018. [DOI: 10.2459/01.jcm.0000549874.10438.3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Nicolè S, Lanzafame M, Cucchetto G, Rigo F, Lattuada E, Concia E. Darunavir/ritonavir 600/100 mg once daily: it’s time for larger non-inferiority randomized trials. J Antimicrob Chemother 2018; 73:1728-1730. [DOI: 10.1093/jac/dky086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Nicolè
- Università degli Studi di Verona, Scuola di Specializzazione in Malattie Infettive e Tropicali, Policlinico ‘G. B. Rossi’, Azienda Ospedaliera Universitaria integrata, Verona, Italia
| | - M Lanzafame
- Unità operative di Malattie Infettive e Tropicali, Policlinico ‘G. B. Rossi’, Azienda Ospedaliera Universitaria integrata, Verona, Italia
| | - G Cucchetto
- Università degli Studi di Verona, Scuola di Specializzazione in Malattie Infettive e Tropicali, Policlinico ‘G. B. Rossi’, Azienda Ospedaliera Universitaria integrata, Verona, Italia
| | - F Rigo
- Unità operative di Malattie Infettive e Tropicali, Policlinico ‘G. B. Rossi’, Azienda Ospedaliera Universitaria integrata, Verona, Italia
| | - E Lattuada
- Unità operative di Malattie Infettive e Tropicali, Policlinico ‘G. B. Rossi’, Azienda Ospedaliera Universitaria integrata, Verona, Italia
| | - E Concia
- Università degli Studi di Verona, Scuola di Specializzazione in Malattie Infettive e Tropicali, Policlinico ‘G. B. Rossi’, Azienda Ospedaliera Universitaria integrata, Verona, Italia
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Faggian F, Azzini A, Lanzafame M, Bonora A, Zorzi A, Concia E, Vento S. Hyperacute Unilateral Gonococcal Endophthalmitis in an HIV-Infected Man without Genital Infection. Eur J Ophthalmol 2018; 16:346-8. [PMID: 16703559 DOI: 10.1177/112067210601600226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To demonstrate the necessity of obtaining an accurate history from patients presenting abnormal evolution of ophthalmologic diseases. METHODS A 42-year-old patient, denying any previous ocular or systemic morbidity, presented with an unusual severe and hyperacute gonococcal endophthalmitis with corneal abscess but no concurrent genitourinary infection. Only after a further interview did the patient reveal his human immunodeficiency virus status and a previous diagnosis of acquired immunodeficiency syndrome. RESULTS Adequate topical and intravenous antibiotic treatment and surgery led to salvage of the eye. CONCLUSIONS An accurate history should be obtained by patients with an abnormal course of an ophthalmologic disease, focusing on immunologic deficiencies that can cause extremely serious ophthalmologic complications with ensuing risk of visual impairment or ocular loss (bulbar enucleation).
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Affiliation(s)
- F Faggian
- Infectious Diseases Unit, Ospedale Civile Maggiore, Verona, Italy.
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5
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Nicolè S, Lanzafame M, Cazzadori A, Vincenzi M, Mangani F, Colato C, El Dalati G, Brazzarola P, Concia E. Successful Antifungal Combination Therapy and Surgical Approach for Aspergillus fumigatus Suppurative Thyroiditis Associated with Thyrotoxicosis and Review of Published Reports. Mycopathologia 2017; 182:839-845. [PMID: 28555254 DOI: 10.1007/s11046-017-0145-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
In immunocompromised patients, Aspergillus infections are important causes of morbidity and mortality. We describe a patient with cryoglobulinemic vasculitis who developed disseminated invasive aspergillosis with thyrotoxicosis caused by Aspergillus fumigatus. The diagnosis was based upon radiological, microbiological and pathological findings. The patient was treated successfully with voriconazole and caspofungin treatment followed by total thyroidectomy. We provide an overview of published reports on Aspergillus thyroiditis with an emphasis on therapeutic approaches.
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Affiliation(s)
- S Nicolè
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy.
| | - M Lanzafame
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - A Cazzadori
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - M Vincenzi
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - F Mangani
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
| | - C Colato
- Department of Pathology, "G. B. Rossi" University Hospital, Verona, Italy
| | - G El Dalati
- Department of Radiology, "G. B. Rossi" University Hospital, Verona, Italy
| | - P Brazzarola
- Department of General Surgery and Pancreatic Surgery, "G. B. Rossi" University Hospital, Verona, Italy
| | - E Concia
- Department of Infectious and Tropical Diseases, "G. B. Rossi" University Hospital, Piazzale L. Scuro 10, 37134, Verona, Italy
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Rigo F, Cucchetto G, Lanzafame M, Nicolè S, Lattuada E, Concia E, Vento S. Dual therapy with a combination of unboosted atazanavir and lamivudine as maintenance treatment in virologically suppressed HIV-1-infected patients. HIV Med 2017; 18:790-792. [PMID: 28503915 DOI: 10.1111/hiv.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F Rigo
- Infectious Diseases Unit, "G.B. Rossi" University Hospital, Verona, Italy
| | - G Cucchetto
- Infectious Diseases Unit, "G.B. Rossi" University Hospital, Verona, Italy
| | - M Lanzafame
- Infectious Diseases Unit, "G.B. Rossi" University Hospital, Verona, Italy
| | - S Nicolè
- Infectious Diseases Unit, "G.B. Rossi" University Hospital, Verona, Italy
| | - E Lattuada
- Infectious Diseases Unit, "G.B. Rossi" University Hospital, Verona, Italy
| | - E Concia
- Infectious Diseases Unit, "G.B. Rossi" University Hospital, Verona, Italy
| | - S Vento
- Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan.,Nazarbayev University Medical Center, Astana, Kazakhstan
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Erdem H, Inan A, Guven E, Hargreaves S, Larsen L, Shehata G, Pernicova E, Khan E, Bastakova L, Namani S, Harxhi A, Roganovic T, Lakatos B, Uysal S, Sipahi OR, Crisan A, Miftode E, Stebel R, Jegorovic B, Fehér Z, Jekkel C, Pandak N, Moravveji A, Yilmaz H, Khalifa A, Musabak U, Yilmaz S, Jouhar A, Oztoprak N, Argemi X, Baldeyrou M, Bellaud G, Moroti RV, Hasbun R, Salazar L, Tekin R, Canestri A, Čalkić L, Praticò L, Yilmaz-Karadag F, Santos L, Pinto A, Kaptan F, Bossi P, Aron J, Duissenova A, Shopayeva G, Utaganov B, Grgic S, Ersoz G, Wu AKL, Lung KC, Bruzsa A, Radic LB, Kahraman H, Momen-Heravi M, Kulzhanova S, Rigo F, Konkayeva M, Smagulova Z, Tang T, Chan P, Ahmetagic S, Porobic-Jahic H, Moradi F, Kaya S, Cag Y, Bohr A, Artuk C, Celik I, Amsilli M, Gul HC, Cascio A, Lanzafame M, Nassar M. The burden and epidemiology of community-acquired central nervous system infections: a multinational study. Eur J Clin Microbiol Infect Dis 2017; 36:1595-1611. [PMID: 28397100 DOI: 10.1007/s10096-017-2973-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 02/12/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.
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Affiliation(s)
- H Erdem
- Principal Coordinator of ID-IRI, Ankara, Turkey.
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, 06010, Etlik, Ankara, Turkey.
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - E Guven
- Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Commonwealth Building, Hammersmith Campus, Imperial College London, London, UK
| | - L Larsen
- Department of Infectious Diseases Q, Odense University Hospital, Odense, Denmark
| | - G Shehata
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - E Pernicova
- Avenier, Centres for Vaccination and Travel Medicine, Prague, Czech Republic
- Faculty Hospital Brno, Department of Infectious Diseases, Brno, Czech Republic
| | - E Khan
- Shifa International Hospital, Islamabad, Pakistan
| | - L Bastakova
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - S Namani
- Infectious Diseases Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - A Harxhi
- Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania
| | - T Roganovic
- Infectious Diseases Clinic, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - B Lakatos
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - S Uysal
- Department of Infectious Diseases and Clinical Microbiology, Seyfi Demirsoy State Hospital, Buca, İzmir, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - A Crisan
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - E Miftode
- Hospital of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - R Stebel
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - B Jegorovic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Z Fehér
- Department of Infectious Diseases, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - C Jekkel
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - N Pandak
- General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia
| | - A Moravveji
- Social Determinants of Health Research Center, Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - H Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - A Khalifa
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - U Musabak
- Department of Immunology and Allergy, Losante Hospital, Ankara, Turkey
| | - S Yilmaz
- Gulhane Medical Academy, Blood Bank, Clinical Microbiology Division, Ankara, Turkey
| | - A Jouhar
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - N Oztoprak
- Antalya Education and Research Hospital, Antalya, Turkey
| | - X Argemi
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - M Baldeyrou
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - G Bellaud
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - R V Moroti
- Carol Davila University of Medicine and Pharmacy and Matei Bals National Institute for Infectious Diseases, Bucharest, Romania
| | - R Hasbun
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Salazar
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - A Canestri
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - L Čalkić
- Department of Infectious Diseases, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina
| | - L Praticò
- University Division of Infectious and Tropical Diseases, Piazza Spedali Civili, 25123, Brescia, Italy
| | - F Yilmaz-Karadag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - L Santos
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Pinto
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Kaptan
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - P Bossi
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - J Aron
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - A Duissenova
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - G Shopayeva
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - B Utaganov
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - S Grgic
- Clinic for Infectious Diseases, University Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - G Ersoz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - A K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K C Lung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - A Bruzsa
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - L B Radic
- Department of Infectious Diseases, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - H Kahraman
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - M Momen-Heravi
- Department of Infectious Diseases, Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - S Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - F Rigo
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Konkayeva
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - Z Smagulova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - T Tang
- Infectious Diseases Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - P Chan
- Neurology Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - S Ahmetagic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - H Porobic-Jahic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - F Moradi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - S Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Y Cag
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - A Bohr
- Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Artuk
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - I Celik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - M Amsilli
- Infectious Diseases Unit, CHU Bicètre, Paris, France
| | - H C Gul
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - A Cascio
- Department of Health Promotion Sciences and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - M Lanzafame
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Nassar
- Infection Control Department, Saudi German Hospital Group, Jeddah, Saudi Arabia
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Calcagno A, Montrucchio C, Capetti A, Guaraldi G, Cenderello G, Calza L, Lanzafame M, Marinaro L, Tettoni MC, Trentini L, D'Avolio A, Di Perri G, Bonora S. Raltegravir Plus Nevirapine as Maintenance Antiretroviral Therapy in HIV-Positive Patients: Safety, Efficacy and Pharmacokinetics. Curr HIV Res 2016; 14:54-60. [PMID: 26415700 DOI: 10.2174/1570162x13666150929112135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 05/12/2015] [Accepted: 09/29/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Tolerability, long-term toxicities and selection of resistant variants limit the use and efficacy of antiretroviral drugs in HIV-positive patients. Novel combinations are needed for mantaining long-term control of HIV replication; nevertheless scarse data are available on protease inhibitor-free dual antiretroviral therapies. METHODS A multi-centric retrospective study was conducted including HIV-1-positive patients on raltegravir/nevirapine dual regimens. Plasma concentrations were measured as therapeutic drug monitoring while a subset of patients underwent intensive 12-hour pharmacokinetic evaluation. RESULTS A total of 77 patients switching from successful regimens (76.6% male, median age 52 years) was included; 10 patients on raltegravir plus nevirapine once-daily while 67 subjects on twice-daily schedule. After a median follow-up of 32 months 69 patients (89.6%) were still successfully on treatment. Three patients discontinued for side effects (skin rash or hepatoxicity). Virological failure was observed in five patients (6.5%, 3 on once-daily schedule): in 4 patients (80%) resistance-associated mutations were observed (4 reverse transcriptase, 2 integrase). Triglycerides decreased in patients switching with lipid abnormalities (n=52) and estimated creatinine clearance increased in those with less than 60 ml/min (n=13). Median trough raltegravir and nevirapine concentrations were 83 ng/ml (32-227) and 5460 ng/ml (4037-7221); intensive 12-hours pharmacokinetic parameters (n=7) were similar to published data. CONCLUSION Dual therapy with raltegravir/nevirapine in selected patients was highly effective over a 32-month follow up: virological failure was infrequent (6.5%), most common with once-daily schedule (60%) and often associated with the selection of resistance-associated mutations (80%). Twice-daily raltegravir plus nevirapine deserves further clinical evaluation as an NRTI- and PI-sparing strategy in selected patients.
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Affiliation(s)
- Andrea Calcagno
- Clinica Univesitaria di Malattie Infettive, Ospedale Amedeo di Savoia, C.so Svizzera 164, 10159, Torino, Italy.
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Lattuada E, Lanzafame M, Concia E, Vento S. Intracranial mass lesions in HIV/AIDS patients from developing countries endemic for neurocysticercosis. Int J STD AIDS 2016; 18:144-5. [PMID: 17331296 DOI: 10.1258/095646207779949754] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bonora S, Rusconi S, Calcagno A, Bracchi M, Viganò O, Cusato J, Lanzafame M, Trentalange A, Marinaro L, Siccardi M, D'Avolio A, Galli M, Di Perri G. Successful pharmacogenetics-based optimization of unboosted atazanavir plasma exposure in HIV-positive patients: a randomized, controlled, pilot study (the REYAGEN study). J Antimicrob Chemother 2015; 70:3096-9. [PMID: 26174719 DOI: 10.1093/jac/dkv208] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/20/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Atazanavir without ritonavir, despite efficacy and tolerability, shows low plasma concentrations that warrant optimization. METHODS In a randomized, controlled, pilot trial, stable HIV-positive patients on atazanavir/ritonavir (with tenofovir/emtricitabine) were switched to atazanavir. In the standard-dose arm, atazanavir was administered as 400 mg once daily, while according to patients' genetics (PXR, ABCB1 and SLCO1B1), in the pharmacogenetic arm: patients with unfavourable genotypes received 200 mg of atazanavir twice daily. EudraCT number: 2009-014216-35. RESULTS Eighty patients were enrolled with balanced baseline characteristics. The average atazanavir exposure was 253 ng/mL (150-542) in the pharmacogenetic arm versus 111 ng/mL (64-190) in the standard-dose arm (P < 0.001); 28 patients in the pharmacogenetic arm (75.7%) had atazanavir exposure >150 ng/mL versus 14 patients (38.9%) in the standard-dose arm (P = 0.001). Immunovirological and laboratory parameters had a favourable outcome throughout the study with non-significant differences between study arms. CONCLUSIONS Atazanavir plasma exposure is higher when the schedule is chosen according to the patient's genetic profile.
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Affiliation(s)
- S Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - S Rusconi
- Department of Infectious Diseases, Ospedale Luigi Sacco, University of Milano, Milano, Italy
| | - A Calcagno
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - M Bracchi
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy St Stephen's Centre, Chelsea and Westminster Hospital, London, UK
| | - O Viganò
- Department of Infectious Diseases, Ospedale Luigi Sacco, University of Milano, Milano, Italy
| | - J Cusato
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - M Lanzafame
- Unit of Diagnosis and Therapy of HIV Infection, 'G. B. Rossi' Hospital, 37134 Verona, Italy
| | - A Trentalange
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - L Marinaro
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - M Siccardi
- Department of Pharmacology, University of Liverpool, Liverpool, UK
| | - A D'Avolio
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
| | - M Galli
- Department of Infectious Diseases, Ospedale Luigi Sacco, University of Milano, Milano, Italy
| | - G Di Perri
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Torino, Italy
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11
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Matinella A, Lanzafame M, Bonometti MA, Gajofatto A, Concia E, Vento S, Monaco S, Ferrari S. Neurological complications of HIV infection in pre-HAART and HAART era: a retrospective study. J Neurol 2015; 262:1317-27. [PMID: 25877836 DOI: 10.1007/s00415-015-7713-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 02/02/2023]
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12
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Affiliation(s)
- M Lanzafame
- Infectious Diseases Unit, Policlinico G.B. Rossi; University of Verona; Verona; Italy
| | - S Bonora
- Department of Infectious Diseases; University of Torino; Torino; Italy
| | - E Lattuada
- Infectious Diseases Unit, Policlinico G.B. Rossi; University of Verona; Verona; Italy
| | - S Vento
- Department of Internal Medicine; School of Medicine, Faculty of Health Sciences; University of Botswana; Gaborone; Botswana
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13
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Mascarello M, Gobbi F, Angheben A, Gobbo M, Gaiera G, Pegoraro M, Lanzafame M, Buonfrate D, Concia E, Bisoffi Z. Prevalence of Strongyloides stercoralis infection among HIV-positive immigrants attending two Italian hospitals, from 2000 to 2009. Ann Trop Med Parasitol 2011; 105:617-23. [PMID: 22325821 PMCID: PMC4089805 DOI: 10.1179/2047773211y.0000000006] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 10/30/2011] [Accepted: 10/31/2011] [Indexed: 12/28/2022]
Abstract
In patients with Strongyloides stercoralis infection, a dysregulation of host immunity can lead to hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), characterized by high fatality rate. HS has been reported in HIV-positive patients following use of corticosteroids or during immune reconstitution inflammatory syndrome (IRIS). A retrospective study was conducted to estimate the prevalence of S. stercoralis infection among HIV-positive immigrants, attending two Italian hospitals. From January 2000 to August 2009, 138 HIV-positive immigrants were systematically screened for strongyloidiasis, as a part of their routine care, with an indirect immunofluorescent antibody test (IFAT) developed at the Centre for Tropical Diseases, Sacro Cuore Hospital of Negrar, Verona. The majority were also submitted to stool examination. Fifteen (11%) resulted infected by S. stercoralis, of whom four (27%) had a negative serology (diagnosis made with stool examination). A higher eosinophil count (0·94 versus 0·24×10(9)/l, P<0·01) and more frequent gastrointestinal and cutaneous symptoms (odds ratio: 4·8 and 5·8, respectively) were found in patients with strongyloidiasis compared with controls. The IFAT is more sensitive than direct parasitological methods. The proportion of false negative results was higher than expected based on the theoretical test sensitivity. Considering the high prevalence detected and the apparent, lower sensitivity of serology, we propose a systematic screening for Strongyloides infection, with both serology and stool culture, for all HIV-positive immigrants coming from endemic areas.
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Affiliation(s)
- M Mascarello
- Policlinico GB Rossi, University of Verona, Italy.
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14
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Angheben A, Anselmi M, Gobbi F, Marocco S, Monteiro G, Buonfrate D, Tais S, Talamo M, Zavarise G, Strohmeyer M, Bartalesi F, Mantella A, Di Tommaso M, Aiello K, Veneruso G, Graziani G, Ferrari M, Spreafico I, Bonifacio E, Gaiera G, Lanzafame M, Mascarello M, Cancrini G, Albajar-Vinas P, Bisoffi Z, Bartoloni A. Chagas disease in Italy: breaking an epidemiological silence. Euro Surveill 2011; 16:19969. [PMID: 21944554] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people(travellers, migrants, blood or organ recipients,newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjectsscreened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees).No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women,three were infected (resulting in abortion in one case).In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.
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Affiliation(s)
- A Angheben
- Centre for Tropical Diseases, Sacro Cuore - Don Calabria Hospital, Negrar, Italy.
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15
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Angheben A, Anselmi M, Gobbi F, Marocco S, Monteiro G, Buonfrate D, Tais S, Talamo M, Zavarise G, Strohmeyer M, Bartalesi F, Mantella A, Di Tommaso M, Aiello KH, Veneruso G, Graziani G, Ferrari MM, Spreafico I, Bonifacio E, Gaiera G, Lanzafame M, Mascarello M, Cancrini G, Albajar-Viñas P, Bisoffi Z, Bartoloni A. Chagas disease in Italy: breaking an epidemiological silence. Euro Surveill 2011. [DOI: 10.2807/ese.16.37.19969-en] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chagas disease, a neglected tropical disease that due to population movements is no longer limited to Latin America, threatens a wide spectrum of people (travellers, migrants, blood or organ recipients, newborns, adoptees) also in non-endemic countries where it is generally underdiagnosed. In Italy, the available epidemiological data about Chagas disease have been very limited up to now, although the country is second in Europe only to Spain in the number of residents from Latin American. Among 867 at-risk subjects screened between 1998 and 2010, the Centre for Tropical Diseases in Negrar (Verona) and the Infectious and Tropical Diseases Unit, University of Florence found 4.2% patients with positive serology for Chagas disease (83.4% of them migrants, 13.8% adoptees). No cases of Chagas disease were identified in blood donors or HIV-positive patients of Latin American origin. Among 214 Latin American pregnant women, three were infected (resulting in abortion in one case). In 2005 a case of acute Chagas disease was recorded in an Italian traveller. Based on our observations, we believe that a wider assessment of the epidemiological situation is urgently required in our country and public health measures preventing transmission and improving access to diagnosis and treatment should be implemented.
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Affiliation(s)
- A Angheben
- Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
- COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America)
| | - M Anselmi
- COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America)
- Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - F Gobbi
- Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
- COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America)
| | - S Marocco
- Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - G Monteiro
- Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - D Buonfrate
- COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America)
- Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - S Tais
- Service of Epidemiology and Laboratory for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - M Talamo
- Infectious Disease Unit, G. Rummo Hospital, Benevento, Italy
| | - G Zavarise
- Paediatric Division, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - M Strohmeyer
- COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America)
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - F Bartalesi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - A Mantella
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - M Di Tommaso
- Obstetric and Gynaecologic Department, Careggi University Hospital, Florence, Italy
| | - K H Aiello
- Obstetric and Gynaecologic Department, Careggi University Hospital, Florence, Italy
| | - G Veneruso
- Infectious Diseases Unit, Anna Meyer Children’s University Hospital, Florence, Italy
| | - G Graziani
- Immunohaematology and Transfusion Unit, Careggi University Hospital, Florence, Italy
| | - M M Ferrari
- Obstetrics and Gynaecology Clinic, L. Mangiagalli Hospital, Milan, Italy
| | - I Spreafico
- Obstetrics and Gynaecology Clinic, L. Mangiagalli Hospital, Milan, Italy
| | - E Bonifacio
- Obstetrics and Gynaecology Division, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - G Gaiera
- Infectious Diseases Division, San Raffaele Hospital, Milan, Italy
| | - M Lanzafame
- Infectious Diseases Division, G.B. Rossi University Hospital, Verona, Italy
| | - M Mascarello
- Infectious Diseases Division, G.B. Rossi University Hospital, Verona, Italy
| | - G Cancrini
- Public Health Sciences Department, La Sapienza University, Rome, Italy
| | - P Albajar-Viñas
- WHO Programme on Control of Chagas disease, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Z Bisoffi
- COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America)
- Centre for Tropical Diseases, Sacro Cuore – Don Calabria Hospital, Negrar, Italy
| | - A Bartoloni
- COHEMI project (COordinating resources to assess and improve HEalth status of MIgrants from Latin America)
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
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16
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Lattuada E, Lanzafame M, Vento S. Can antiretroviral therapy be safely interrupted and, if so, when? HIV Med 2011; 12:126-7. [PMID: 21446942 DOI: 10.1111/j.1468-1293.2010.00853.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Trichothiodystrophy (TTD) is an autosomal recessive disorder with symptoms affecting several tissues and organs. The most relevant features are hair abnormalities, physical and mental retardation, ichthyosis, signs of premature aging and cutaneous photosensitivity. The clinical spectrum of TTD varies widely from patients with only brittle, fragile hair to patients with the most severe neuroectodermal symptoms. To date, four genes have been identified as responsible for TTD: XPD, XPB, p8/TTDA, and TTDN1. Whereas the function of TTDN1 is still unknown, the former three genes encode subunits of TFIIH, the multiprotein complex involved in basal and activated transcription and in nucleotide excision repair (NER). Ongoing investigations on TTD are elucidating not only the pathogenesis of the disease, which appears to be mainly related to transcriptional impairment, but also the modalities of NER and transcription in human cells and how TFIIH operates in these two fundamental cellular processes.
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Affiliation(s)
- M Stefanini
- Istituto di Genetica Molecolare CNR, via Abbiategrasso 207, Pavia, Italy.
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18
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Lattuada E, Vallone A, Lanzafame M, Corsini F, Concia E, Vento S. Prior Mycobacterium aviumcomplex infection is linked to immunological nonresponsiveness in HIV-infected patients on highly active antiretroviral therapy. HIV Med 2010; 11:542-3. [PMID: 20236362 DOI: 10.1111/j.1468-1293.2009.00821.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Lanzafame M, Lattuada E, Corsini F. Comment on: Unboosted fosamprenavir is associated with low drug exposure in HIV-infected patients with mild-moderate liver impairment resulting from HCV-related cirrhosis. J Antimicrob Chemother 2009; 64:215-6; author reply 216. [DOI: 10.1093/jac/dkp105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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20
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Lanzafame M, Ferrari S, Lattuada E, Corsini F, Deganello R, Vento S, Concia E. Mirtazapine in an HIV-1 infected patient with progressive multifocal leukoencephalopathy. Infez Med 2009; 17:35-37. [PMID: 19359824] [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: 05/27/2023]
Abstract
We describe the clinical course of an HIV-infected patient with progressive multifocal leukoencephalopathy who took mirtazapine for his depression. After six months of therapy the clinical symptoms had not worsened and the neuroradiological image of the brain was unchanged. Further studies are necessary to determine the effect of serotonin receptor antagonist in treating PML associated to HIV.
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Affiliation(s)
- M Lanzafame
- Unit of Infectious Diseases, University of Verona, Ospedale Policlinico,Verona, Italy
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21
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Berretta M, Lanzafame M, Montesarchio V, Ortolani P, Cinelli R, Di Benedetto F, Spina M, Lleshi A, Simonelli C, Tirelli U. FOLFOX4 and concomitant highly active antiretroviral therapy (HAART) in metastatic colorectal cancer (M-CRC) HIV-positive patients (pts): A GICAT experience. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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22
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Bonora S, Lanzafame M, D'Avolio A, Trentini L, Lattuada E, Concia E, Di Perri G. Drug Interactions between Warfarin and Efavirenz or Lopinavir-Ritonavir in Clinical Treatment. Clin Infect Dis 2008; 46:146-7. [DOI: 10.1086/524086] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
During the past few years, efavirenz has been increasingly used in the treatment of HIV1 infection. Its main side effect is a syndrome of central nervous system stimulation occurring in 40-50% of adults in the first few weeks of therapy which might be observed at increased frequency in subjects concurrently using recreational substances. We therefore conducted a single center, retrospective study in 134 patients treated with efavirenz and found no significant differences in CNS side effects or discontinuation rates between recreational substance (cocaine, ecstasy, cannabis) users and non-users. Although our study is limited, the results support the idea that efavirenz can be safely prescribed to patients using recreational substances.
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Affiliation(s)
- F Faggian
- Infectious Diseases Unit, Civile Maggiore Hospital, and Section of Infectious Diseases, Department of Pathology, University of Verona, Verona, Italy
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24
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Ferrari S, Cavallaro T, Lanzafame M, Malena M, Rizzuto N. Painful neuropathy vasculitis in HIV infection. J Peripher Nerv Syst 2004. [DOI: 10.1111/j.1085-9489.2004.009209bl.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Lanzafame M, Faggian F, Lattuada E, Ramarli D, Concia E, Vento S. Is there a role for TNF-alpha in HIV1-associated lipodystrophy? Eur J Clin Invest 2003; 33:735-6. [PMID: 12864788 DOI: 10.1046/j.1365-2362.2003.01211.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Lanzafame M, Mazzi R, Di Pace C, Trevenzoli M, Concia E, Vento S. Unusual, rapidly growing ulcerative genital mass due to herpes simplex virus in a human immunodeficiency virus-infected woman. Br J Dermatol 2003; 149:216-7. [PMID: 12890233 DOI: 10.1046/j.1365-2133.2003.05415.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Trevenzoli M, Cattelan AM, Rea F, Sasset L, Semisa M, Lanzafame M, Meneghetti F, Cadrobbi P. Mediastinitis due to cryptococcal infection: a new clinical entity in the HAART era. J Infect 2002; 45:173-9. [PMID: 12387774 DOI: 10.1016/s0163-4453(02)91052-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Highly active antiretroviral therapy (HAART) produces a rapid decline in plasma HIV-1 RNA levels with concomitant immune reconstitution. Probably due to the enhanced immune function, shortly after starting HAART, some latent opportunistic infections precipitated. The aim of this study was to illustrate the results of a survey on Cryptococcus associated mediastinitis occurring after HAART introduction, carried out at a referral centre of Infectious Diseases in the north-east of Italy, between October 1999 and October 2000. METHODS All consecutive HIV-positive patients, naive to HIV-protease inhibitor therapy, and diagnosed with culture-proven cryptococcal infection were included in the study. Clinical and immuno-virological parameters before HAART and subsequently for 12 months were evaluated. RESULTS Three of five patients were diagnosed with cryptococcal mediastinitis within a median time of 90 days (range, 60-150) after commencing HAART and fluconazole prophylaxis. Diagnosis was established by lymph node biopsy alone. Clinical improvement was documented when systemic anti-fungal therapy was combined with surgical drainage of the suppurative lesions. The role of immune restoration was confirmed by the significant increase in CD4 cell count, the reduction of HIV-RNA to undetectable levels and the prominent inflammatory reactions of lymph nodes. CONCLUSIONS Our report suggests that HIV-positive patients with prior cryptococcal systemic infection may present a re-exacerbation of atypical cryptococcosis as a manifestation of immune restoration, even when fluconazole prophylaxis is ongoing.
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Affiliation(s)
- M Trevenzoli
- Infectious Diseases Division, General Hospital and University of Padua, Italy
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28
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Trevenzoli M, Cattelan A, Rea F, Sasset L, Semisa M, Lanzafame M, Meneghetti F, Cadrobbi P. Mediastinitis Due to Cryptococcal Infection: A New Clinical Entity in the HAART Era. J Infect 2002. [DOI: 10.1053/jinf.2002.1052] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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29
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Lanzafame M, Rovere P, De Checchi G, Trevenzoli M, Turazzini M, Parrinello A. Hypersensitivity syndrome (DRESS) and meningoencephalitis associated with nevirapine therapy. Scand J Infect Dis 2002; 33:475-6. [PMID: 11450872 DOI: 10.1080/00365540152029990] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The DRESS (drug rash with eosinophilia and systemic symptoms) syndrome is a serious condition that has been reported in association with various drugs, such as allopurinol, sulfonamides and aromatic anticonvulsants. Recently the condition has been described in HIV-infected patients taking antiretroviral agents. We report the first case, to our knowledge, of DRESS syndrome complicated by meningoencephalitis associated with nevirapine therapy.
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Affiliation(s)
- M Lanzafame
- Unità Operativa di Malattie Infettive, Ospedale Civile di Legnago, Verona, Italy
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30
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Lanzafame M, Trevenzoli M, Faggian F, Marcati P, Gatti F, Carolo G, Concia E. Interaction between levothyroxine and indinavir in a patient with HIV infection. Infection 2002; 30:54-5. [PMID: 11876520 DOI: 10.1007/s15010-002-2092-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Drug interactions are an important and emerging problem in the treatment of HIV-infected patients. Protease inhibitors, like nonnucleoside reverse transcriptase inhibitors, are metabolized by the cytochrome P-450 enzyme system and each of these antiretroviral agents may interact with other drugs metabolized by this system. Some protease inhibitors may also interact with glucuronosyl transferase activity affecting plasma concentrations of drugs metabolized through this pathway. We describe a case of an HIV-infected patient, taking levothyroxine for hypothyroidism and clinically stable, who, after the introduction of an antiretroviral regimen containing indinavir, developed a pharmacological hyperthyroidism.
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31
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Cattelan AM, Trevenzoli M, Sasset L, Sgarabotto D, Lanzafame M, Meneghetti F. Toxic epidermal necrolysis induced by nevirapine therapy: description of two cases and review of the literature. J Infect 2001; 43:246-9. [PMID: 11869062 DOI: 10.1053/jinf.2001.0902] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe two cases of toxic epidermal necrolysis developed during an antiretroviral therapy regimen containing nevirapine. It seems likely that the poor adherence to the dose escalation regimen of nevirapine has caused this life-threatening disease. A complete and written information on the scheduled antiretroviral therapy is mandatory, above all for individuals coming from developing countries where language barriers have not yet been successfully overcome.
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Affiliation(s)
- A M Cattelan
- Division of Infectious Diseases, General Hospital of Padua, Italy.
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Lanzafame M, Trevenzoli M, Vento S, Parrinello A. Clinical picture: tuberculous chorioretinitis. Lancet 2001; 357:1390. [PMID: 11356435 DOI: 10.1016/s0140-6736(00)04622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Lanzafame
- Unita Operativa di Malattie Infettive, Ospedale Civile Legnago, Verona, Italy
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Lanzafame M, Trevenzoli M, Cattelan AM, Rovere P, Parrinello A. Directly observed therapy in HIV therapy: A realistic perspective? J Acquir Immune Defic Syndr 2000; 25:200-1. [PMID: 11103053 DOI: 10.1097/00042560-200010010-00018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lanzafame M, Carretta G, Trevenzoli M, Lazzarini L, Vento Ercole Concia S. Successful treatment of Castleman's disease with HAART in two HIV-infected patients. J Infect 2000; 40:90-1. [PMID: 10762119 DOI: 10.1053/jinf.1999.0598] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Castleman's disease is a heterogeneous group of lymphoproliferative disorders of unknown aetiology. Recently, human herpesvirus type 8 (HHV-8) has been associated with various diseases in individuals with HIV infection, including Kaposi's sarcoma, B cell non Hodgkin's lymphomas, and Castleman's disease. In Castleman's disease it has been hypothesized that HHV-8, encoding a number of various virokines, can be responsible for clinical manifestations of the disease.Previously, two reports have described a clinical recovery from HIV-associated Castleman's disease: by administration of a monoclonal antibody neutralizing human IL-6 in one case, and in another case by treatment with highly antiretroviral therapy and anti-herpesvirus therapy, following splenectomy. We report two cases where HAART alone led to clinical recovery from Castleman's disease. In both the cases reported here, although follow-up biopsy was not performed, it is likely that the inhibition of HHV-8 replication and of virokine release, through the restoration of immunity by HAART, was the basis for the disappearance of the clinical symptoms.
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Affiliation(s)
- M Lanzafame
- Istituto di Immunologia e Malattie Infettive, Ospedale Civile Maggiore Borgo Trento, Verona, Italy
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Di Perri G, Vento S, Mazzi R, Bonora S, Bonora A, Trevenzoli M, Allegranzi B, Carretta G, Lanzafame M, Pizzighella S, Concia E. Recovery of long-term natural protection against reactivation of CMV retinitis in AIDS patients responding to highly active antiretroviral therapy. J Infect 1999; 39:193-7. [PMID: 10714794 DOI: 10.1016/s0163-4453(99)90048-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To see whether in severely immunosuppressed AIDS patients (with prior Cytomegalovirus retinal disease) who have significant increases in CD4+ lymphocytes following the initiation of highly active antiretroviral therapy (HAART) anti-Cytomegalovirus (CMV) maintenance therapy can be withdrawn with no subsequent progression of CMV retinitis. METHODS Eight patients with AIDS and one or more previous episodes of CMV retinitis interrupted anti-CMV maintenance therapy following the successful beginning of HAART. CD4 cell counts and HIV-RNA were monitored monthly while measurement of CMV antigenemia and ophthalmoscopy were carried every 2 weeks thereafter. RESULTS The HAART recipients in whom anti-CMV maintenance therapy had been interrupted had measureable increases of CD4+ T lymphocytes, substantial control of both HIV-RNA and CMV viraemia and did not show recurrence of retinitis during a mean follow-up of 98.4 weeks (range 78-120, SD 15.2). CONCLUSIONS Anti-CMV maintenance therapy can be interrupted with no subsequent progression of retinal damage over a long time in patients with AIDS who successfully respond to HAART with a significant increase in CD4 cell count.
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Affiliation(s)
- G Di Perri
- The Institute of Immunology and Infectious Diseases, University of Verona, Italy
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Lanzafame M, Trevenzoli M, Carretta G, Lazzarini L, Vento S, Concia E. Mediastinal lymphadenitis due to cryptococcal infection in HIV-positive patients on highly active antiretroviral therapy. Chest 1999; 116:848-9. [PMID: 10492309 DOI: 10.1378/chest.116.3.848-a] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lanzafame M, Bonora S, Di Perri G, Allegranzi B, Guasparri I, Cazzadori A, Ferrari S, Vento S, Concia E. Microsporidium species in pulmonary cavitary lesions of AIDS patients infected with Rhodococcus equi. Clin Infect Dis 1997; 25:926-7. [PMID: 9356815 DOI: 10.1086/597641] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- M Lanzafame
- Institute of Immunology and Infectious Diseases, University of Verona, Italy. p6
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Bonora S, Lanzafame M, Allegranzi B, Soldani F, Vento S, Cazzadori A, Di Perri G, Concia E. Comparative evaluation of naturally occurring Pneumocystis carinii pneumonia (PCP) and PCP despite primary chemoprophylaxis in patients with AIDS. J Infect 1997; 35:201. [PMID: 9354363 DOI: 10.1016/s0163-4453(97)92073-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Di Perri G, Olliaro P, Nardi S, Allegranzi B, Deganello R, Vento S, Lanzafame M, Cazzadori A, Bonora S, Concia E. The ParaSight-F rapid dipstick antigen capture assay for monitoring parasite clearance after drug treatment of Plasmodium falciparum malaria. Trans R Soc Trop Med Hyg 1997; 91:403-5. [PMID: 9373633 DOI: 10.1016/s0035-9203(97)90257-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Three methods for the detection of Plasmodium falciparum infection in peripheral blood were compared during antimalarial treatment and follow-up in 32 Burundian patients: dipstick antigen capture assay, standard (TBF) and prolonged thick blood film examination (PTBF) (3 x 5 min and 3 x 20 min examination respectively). Parasitaemia was determined daily by comparison with total white blood cell counts (determined by Coulter counter) until no parasite was detected on 2 consecutive days by PTBF. Cumulatively, 231 observations were made with each assay: 64 were negative and 167 positive by PTBF (59 had parasite counts < or = 100/microL). Compared to PTBF, the sensitivities of TBF and the dipstick assay were 1.0 for parasite counts > 100/microL and 0.458 and 0.966 respectively for counts < or = 100/microL. Overall, the dipstick assay was significantly more sensitive (0.988 vs. 0.808; P < 0.001) but less specific (P = 0.013) than TBF. The dipstick assay is of potential use for monitoring response to drug treatment and for detecting low parasitaemias.
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Affiliation(s)
- G Di Perri
- Institute of Immunology and Infectious Diseases, University of Verona, Italy
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Cazzadori A, Di Perri G, Bonora S, Lanzafame M, Allegranzi B, Concia E. Fatal pneumothorax complicating BAL in a bone marrow transplant recipient with bronchiolitis obliterans. Chest 1997; 111:1468-9. [PMID: 9149624 DOI: 10.1378/chest.111.5.1468-b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Abstract
Patients undergoing mechanical ventilation (MV) after an isolated closed head injury (ICHI) have often been found to develop hospital-acquired pneumonia (HAP) well before subjects who require MV for different reasons. In a prospective study of patients receiving MV after an ICHI. 38 subjects (out of 65 with clinically suspected HAP) had a bacteriological diagnosis established on the basis of correspondence between cultures made from bronchoalveolar lavage and protected specimen brush (with quantitative thresholds of 10(4) and 10(3) cfu ml-1, respectively). Patients were separated according to the time of onset of HAP, with 20 subjects who developed HAP within 4 days of the start of MV (early onset pneumonia, EOP) and 18 subjects who developed HAP after the fourth day (late onset pneumonia, LOP). In those who had LOP, an expected spectrum of organisms was found, with Gram-negatives (especially Pseudomonas sp.) accounting for the majority of isolates. However, in EOP cases, Gram-positive bacteria (especially Staphylococcus sp. and Streptococcus pneumoniae) were found to largely predominate (P = 0.0000026). This confirms the high incidence of staphylococcal pneumonia in neurosurgery patients, and also provides evidence that the vast majority of such staphylococcal pneumonia are EOP. Unlike most previous reports, the microbiological findings from the present study suggest that a cut-off point of 4 days successfully distinguishes between EOP and LOP. Since these two clinical entities differ significantly in terms of pathogenesis and aetiology, preventive measures and therapeutical protocols have to be tailored accordingly.
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Affiliation(s)
- A Cazzadori
- Bronchoscopy Unit, University of Verona, Italy
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Soldani F, Lanzafame M, Allegranzi B, Bonora S, Tessari G, Di Perri G, Concia E. Cryptococcal dermatitis with negative antigenaemia heralding disseminated disease in HIV infection. J Infect 1996; 33:240-1. [PMID: 9081987 DOI: 10.1016/s0163-4453(96)92489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Di Perri G, Cazzadori A, Vento S, Bonora S, Malena M, Bontempini L, Lanzafame M, Allegranzi B, Concia E. Comparative histopathological study of pulmonary tuberculosis in human immunodeficiency virus-infected and non-infected patients. Tuber Lung Dis 1996; 77:244-9. [PMID: 8758108 DOI: 10.1016/s0962-8479(96)90008-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
SETTING Clinical features of human immunodeficiency virus (HIV)-associated tuberculosis depend upon the patients' residual immunity. An immune-dependent presentation has also been described at the histopathological level in many extra-pulmonary sites, but no descriptions have so far been made on the histopathology of HIV-associated pulmonary tuberculosis. OBJECTIVE To compare the histopathological features of pulmonary tuberculosis in HIV-infected subjects and seronegative patients. DESIGN We carried out a retrospective comparative study on 16 HIV-infected subjects and 16 seronegative patients with culture-proven pulmonary tuberculosis who underwent transbronchial biopsy. We evaluated the bacillary burden and the parenchymal inflammatory reaction by means of a four-graded scoring system giving an approximate quantitative measure of the two parameters. RESULTS HIV-associated pulmonary tuberculosis was found to differ significantly from disease forms seen in seronegative patients, with a significant tendency to develop highly bacillary and poorly reactive histopathological pictures along with the downgrading evolution of immune function. CONCLUSION Pathologic features of pulmonary tuberculosis in HIV-infected subjects differ from those encountered in seronegative patients depending upon the individual immunity of the former. HIV-associated progressive depletion of CD4+ lymphocytes leads to substantial changes in pulmonary reactivity to Mycobacterium tuberculosis; multibacillary pictures in a background of loose inflammatory reactions are quite common findings at the extreme phase of HIV-related immune deterioration.
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Affiliation(s)
- G Di Perri
- Institute of Immunology and Infectious Diseases, University of Verona, Italy
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