1
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Brugnoli B, Salvati L, Di Lauria N, Botta A, Tozzetti C, Biscarini A, Capone M, Ferrentino F, Naldi C, Ascione G, Mazzoni A, Maggi L, Campo I, Carey B, Trapnell B, Liotta F, Cosmi L, Bartoloni A, Annunziato F, Parronchi P, Palterer B. Disseminated nocardiosis and anti-GM-CSF antibodies. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04785-z. [PMID: 38379052 DOI: 10.1007/s10096-024-04785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/12/2024] [Indexed: 02/22/2024]
Abstract
Infections that are unusually severe or caused by opportunistic pathogens are a hallmark of primary immunodeficiency (PID). Anti-cytokine autoantibodies (ACA) are an emerging cause of acquired immunodeficiency mimicking PID. Nocardia spp. are Gram-positive bacteria generally inducing disseminated infections in immunocompromised patients, but seldom also occurring in apparently immunocompetent hosts. Anti-GM-CSF autoantibodies are associated with autoimmune pulmonary alveolar proteinosis (PAP). In those patients, an increased incidence of disseminated nocardiosis and cryptococcosis has been observed. It is unclear whether the PAP or the autoantibodies predispose to the infection. We report an apparently immunocompetent woman presenting with disseminated nocardiosis without any evidence of PAP. Clinical data and radiological images were retrospectively collected. Lymphocyte populations were analyzed by flow cytometry. Anti-GM-CSF autoantibodies were measured by ELISA. A 55-year-old otherwise healthy woman presented with cerebral and pulmonary abscesses. Personal and familial history of infections or autoimmunity were negative. After extensive examinations, a final diagnosis of disseminated nocardiosis was made. Immunologic investigations including neutrophilic function and IFN-γ/IL-12 circuitry failed to identify a PID. Whole-exome sequencing did not find pathogenic variants associated with immunodeficiency. Serum anti-GM-CSF autoantibodies were positive. There were no clinical or instrumental signs of PAP. Trimethoprim-sulfamethoxazole and imipenem were administered, with progressive improvement and recovery of the infectious complication. We identified anti-GM-CSF autoantibodies as the cause of disseminated nocardiosis in a previously healthy and apparently immunocompetent adult. This case emphasizes the importance of including ACA in the differential diagnosis of PID, especially in previously healthy adults. Importantly, anti-GM-CSF autoantibodies can present with disseminated nocardiosis without PAP.
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Affiliation(s)
- Barbara Brugnoli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Nicoletta Di Lauria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Camilla Tozzetti
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - Alessandro Biscarini
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-Careggi University Hospital, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Chiara Naldi
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - Giovanni Ascione
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Ilaria Campo
- Pneumology Unit, Internal Medicine and Infectious Diseases Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Brenna Carey
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce Trapnell
- Translational Pulmonary Science Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunoallergology Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cell Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Boaz Palterer
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy.
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2
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Lamacchia G, Salvati L, Kiros ST, Mazzoni A, Vanni A, Capone M, Carnasciali A, Farahvachi P, Lagi F, Di Lauria N, Rocca A, Colao MG, Liotta F, Cosmi L, Rossolini GM, Bartoloni A, Maggi L, Annunziato F. Fourth Dose of mRNA COVID-19 Vaccine Transiently Reactivates Spike-Specific Immunological Memory in People Living with HIV (PLWH). Biomedicines 2022; 10:3261. [PMID: 36552017 PMCID: PMC9775459 DOI: 10.3390/biomedicines10123261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Background: People Living With HIV (PLWH), with advanced disease, lower CD4+ T cell counts or an unsuppressed HIV viral load can have a suboptimal vaccine response. For this reason, in the current COVID-19 pandemic, they represent a prioritized population for the SARS-CoV-2 fourth (or second booster) vaccine dose. This work aims to investigate the effects of a second booster on the reactivation of the spike-specific humoral and cell-mediated immune responses in PLWH. Methods: A total of eight PLWH, who received a fourth dose of the original mRNA vaccines were enrolled. They were evaluated before and then 7 days, 1 month and 2 months after the injection. The humoral response was assessed via a chemiluminescent immunoassay. Immunophenotyping and the functional evaluation of the SARS-CoV-2-specific cellular immune responses were performed via flow cytometry. Results: Anti-spike IgG levels were above the cut-off value for all subjects at all timepoints. The spike-specific CD4+ T cell response was reactivated one week after the fourth vaccine dose, and on average declined at two months post-vaccination. A similar trend was observed for the spike-specific B cells. A low percentage of spike-specific CD4+ T cells was activated by the B.1.1.529 BA.1 Omicron-spike mutated peptides, and the majority of these cells were reactive to the conserved portions of the spike protein. Similarly, the majority of the spike-specific memory B cells were able to bind both Wuhan and Omicron-spike entire protein. Conclusions: Spike-specific adaptive immune responses are transiently reactivated in PLWH following the fourth mRNA vaccine dose. The breadth of the immune responses to the mutated spike protein provides insight on the possible cross-reactivity for the SARS-CoV-2 variants of concern (VOCs).
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Affiliation(s)
- Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Seble Tekle Kiros
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
| | - Alberto Carnasciali
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Parham Farahvachi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Filippo Lagi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Nicoletta Di Lauria
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Arianna Rocca
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Maria Grazia Colao
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
- Immunology and Cell Therapy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Immunoallergology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, 50134 Florence, Italy
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3
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Mazzoni A, Vanni A, Spinicci M, Lamacchia G, Kiros ST, Rocca A, Capone M, Di Lauria N, Salvati L, Carnasciali A, Mantengoli E, Farahvachi P, Zammarchi L, Lagi F, Colao MG, Liotta F, Cosmi L, Maggi L, Bartoloni A, Rossolini GM, Annunziato F. SARS-CoV-2 infection and vaccination trigger long-lived B and CD4+ T lymphocytes: implications for booster strategies. J Clin Invest 2022; 132:157990. [PMID: 35139036 PMCID: PMC8920339 DOI: 10.1172/jci157990] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | - Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | - Arianna Rocca
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Carnasciali
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Parham Farahvachi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | | | | | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cell Therapy Unit, and
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Immunology and Cell Therapy Unit, and
| | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
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4
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Barbarisi G, Piccica M, Zavagli M, Bandini G, Di Lauria N, Antonelli A, Spinicci M, Rossolini GM, Bartoloni A, Moggi Pignone A, Zammarchi L. Hookworm infection presenting as recurrent severe anaemia requiring blood transfusion in a Pakistani migrant to Italy. J Travel Med 2022; 29:6446352. [PMID: 34865110 DOI: 10.1093/jtm/taab184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/14/2021] [Indexed: 11/13/2022]
Abstract
We report a case of hookworm infection presenting as recurrent severe anaemia in an adult Pakistani migrant to Italy. Clinicians working in non-endemic countries should be aware of this possible cause of anaemia, approachable by a microscopic stool examination that could avoid invasive and time-consuming diagnostic work-up.
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Vellere I, Di Lauria N, Mantella A, Cavallo A, Bresci S, Bartoloni A, Zammarchi L. Atypical imported severe primary dengue presenting with neutrophilic leukocytosis and cardiac tamponade in a young female traveler. J Travel Med 2021; 28:6274744. [PMID: 33987662 DOI: 10.1093/jtm/taab074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/14/2022]
Abstract
We report an atypical imported severe primary dengue presenting with neutrophilic leukocytosis, elevated inflammatory markers, myopericarditis and cardiac tamponade. Dengue Fever (DF) cannot be excluded in patients presenting with neutrophilic leukocytosis and elevated inflammatory markers which may anticipate severe dengue with myocardial involvement.
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Affiliation(s)
- Iacopo Vellere
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Nicoletta Di Lauria
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Annalisa Cavallo
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Bresci
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
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6
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Mazzoni A, Di Lauria N, Maggi L, Salvati L, Vanni A, Capone M, Lamacchia G, Mantengoli E, Spinicci M, Zammarchi L, Kiros ST, Rocca A, Lagi F, Colao MG, Parronchi P, Scaletti C, Turco L, Liotta F, Rossolini GM, Cosmi L, Bartoloni A, Annunziato F. First-dose mRNA vaccination is sufficient to reactivate immunological memory to SARS-CoV-2 in subjects who have recovered from COVID-19. J Clin Invest 2021; 131:149150. [PMID: 33939647 DOI: 10.1172/jci149150] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [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: 03/01/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022] Open
Abstract
The characterization of the adaptive immune response to COVID-19 vaccination in individuals who recovered from SARS-CoV-2 infection may define current and future clinical practice. To determine the effect of the 2-dose BNT162b2 mRNA COVID-19 vaccination schedule in individuals who recovered from COVID-19 (COVID-19-recovered subjects) compared with naive subjects, we evaluated SARS-CoV-2 Spike-specific T and B cell responses, as well as specific IgA, IgG, IgM, and neutralizing antibodies titers in 22 individuals who received the BNT162b2 mRNA COVID-19 vaccine, 11 of whom had a previous history of SARS-CoV-2 infection. Evaluations were performed before vaccination and then weekly until 7 days after second injection. Data obtained clearly showed that one vaccine dose is sufficient to increase both cellular and humoral immune response in COVID-19-recovered subjects without any additional improvement after the second dose. On the contrary, the second dose proved mandatory in naive subjects to further enhance the immune response. These findings were further confirmed at the serological level in a larger cohort of naive (n = 68) and COVID-19-recovered (n = 29) subjects, tested up to 50 days after vaccination. These results question whether a second vaccine injection in COVID-19-recovered subjects is required, and indicate that millions of vaccine doses may be redirected to naive individuals, thus shortening the time to reach herd immunity.
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Affiliation(s)
- Alessio Mazzoni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Laura Maggi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Salvati
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Vanni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Manuela Capone
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giulia Lamacchia
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Seble Tekle Kiros
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Arianna Rocca
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Cristina Scaletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Francesco Liotta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Microbiology and Virology Unit
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Immunology and Cell Therapy Unit
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit
| | - Francesco Annunziato
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Flow Cytometry Diagnostic Center and Immunotherapy, Careggi University Hospital, Florence, Italy
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7
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Suardi LR, Di Lauria N, Pozzi M, Rogasi PG, Barilaro A, Azzolini F, Prestipino E, Colao MG, Rossolini GM, Bartoloni A. Acute cerebellar ataxia: a rare Toscana Virus (TOSV) meningoencephalitis complication. Int J Neurosci 2019; 130:276-278. [PMID: 31554442 DOI: 10.1080/00207454.2019.1673748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Arbovirosis, viral infection transmitted by arthropods, is a widespread health problem. In Italy, as well for all Mediterranean basin, from late spring to the end of summer, Toscana Virus (TOSV), a sandfly borne virus, accounts for the majority of aseptic meningitis/meningoencephalitis cases. TOSV meningitis/meningoencephalitis has usually a self-extinguishing benign course. Our aim is to report a case of a young healthy women diagnosed with Toscana Virus meningoencephalitis with a complicated clinical course.Materials and methods/results: Case report of a 33-years old woman, admitted to the Infectious Diseases Unit at Careggi General Hospital (Florence-Italy), with a diagnosis of Toscana Virus meningoencephalitis. Seventy-two hours after the admission, she developed typical symptoms, as impaired legs coordination, slurred speech, stumbling and dysmetria, of acute cerebellar ataxia (ACA). Urgent neurological assessment was provided performing an electroencephalography study followed by a brain and brainstem magnetic resonance imaging. In the meanwhile, bilateral nystagmus arised. Through neurologist consultation ACA clinical diagnosis was then made and intravenous steroid therapy was administered with prompt symptoms resolution. The patient was finally discharged at day 10 since the ACA onset in good clinical conditions.Conclusions: To raise awareness among physicians about possible neurological complications during Toscana Virus meningoencephalitis.
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Affiliation(s)
| | - Nicoletta Di Lauria
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy
| | - Marco Pozzi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Pier Giorgio Rogasi
- SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alessandro Barilaro
- Dipartimento NEUROFARBA, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | | | - Elio Prestipino
- Dipartimento NEUROFARBA, Università di Firenze, Florence, Italy
| | - Maria Grazia Colao
- SOD Microbiologia e Virologia, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Gian Maria Rossolini
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy.,SOD Microbiologia e Virologia, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alessandro Bartoloni
- Dipartimento di Medicina Sperimentale e Clinica, Università di Firenze, Florence, Italy.,SOD Malattie Infettive e Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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8
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Giacobbe DR, Saffioti C, Losito AR, Rinaldi M, Aurilio C, Bolla C, Boni S, Borgia G, Carannante N, Cassola G, Ceccarelli G, Corcione S, Dalla Gasperina D, De Rosa FG, Dentone C, Di Bella S, Di Lauria N, Feasi M, Fiore M, Fossati S, Franceschini E, Gori A, Granata G, Grignolo S, Grossi PA, Guadagnino G, Lagi F, Maraolo AE, Marinò V, Mazzitelli M, Mularoni A, Oliva A, Pace MC, Parisini A, Patti F, Petrosillo N, Pota V, Raffaelli F, Rossi M, Santoro A, Tascini C, Torti C, Trecarichi EM, Venditti M, Viale P, Signori A, Bassetti M, Del Bono V, Giannella M, Mikulska M, Tumbarello M, Viscoli C. Use of colistin in adult patients: A cross-sectional study. J Glob Antimicrob Resist 2019; 20:43-49. [PMID: 31207379 DOI: 10.1016/j.jgar.2019.06.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/03/2019] [Accepted: 06/08/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The aim of this study was to assess colistin use in a country endemic for multidrug-resistant Gram-negative bacteria (MDR-GNB). METHODS Colistin prescription patterns were evaluated in 22 Italian centres. Factors associated with use of colistin in combination with other anti-MDR-GNB agents were also assessed. RESULTS A total of 221 adults receiving colistin were included in the study. Their median age was 64 years (interquartile range 52-73 years) and 134 (61%) were male. Colistin was mostly administered intravenously (203/221; 92%) and mainly for targeted therapy (168/221; 76%). The most frequent indications for colistin therapy were bloodstream infection and lower respiratory tract infection. Intravenous colistin was administered in combination with at least another anti-MDR-GNB agent in 80% of cases (163/203). A loading dose of 9 MU of colistimethate was administered in 79% of patients receiving i.v. colistin and adequate maintenance doses in 85%. In multivariable analysis, empirical therapy [odds ratio (OR) = 3.25, 95% confidence interval (CI) 1.24-8.53;P = 0.017] and targeted therapy for carbapenem-resistant Enterobacterales infection (OR = 4.76, 95% CI 1.69-13.43; P = 0.003) were associated with use of colistin in combination with other agents, whilst chronic renal failure (OR = 0.39, 95% CI 0.17-0.88; P = 0.024) was associated with use of colistin monotherapy. CONCLUSION Colistin remains an important option for severe MDR-GNB infections when other treatments are not available. Despite inherent difficulties in optimising its use owing to peculiar pharmacokinetic/pharmacodynamic characteristics, colistin was mostly used appropriately in a country endemic for MDR-GNB.
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Affiliation(s)
| | - Carolina Saffioti
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Angela Raffaella Losito
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Rinaldi
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Caterina Aurilio
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Cesare Bolla
- SC Malattie Infettive, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Silvia Boni
- Divisione di Malattie Infettive, Ospedale Sant'Andrea, La Spezia, Italy
| | - Guglielmo Borgia
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Novella Carannante
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Giovanni Cassola
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Daniela Dalla Gasperina
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Chiara Dentone
- Medical Department, Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy
| | - Stefano Di Bella
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Nicoletta Di Lauria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marcello Feasi
- Department of Infectious Diseases, Galliera Hospital, Genoa, Italy
| | - Marco Fiore
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Sara Fossati
- Infectious Diseases Department, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Erica Franceschini
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Gori
- University of Milan and Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Guido Granata
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Sara Grignolo
- Divisione di Malattie Infettive, Ospedale Sant'Andrea, La Spezia, Italy
| | - Paolo Antonio Grossi
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Filippo Lagi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | | | - Maria Mazzitelli
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | | | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy; IRCCS INM Neuromed, Pozzilli, Italy
| | - Maria Caterina Pace
- Department of Anaesthesiological, Surgical and Emergency Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Andrea Parisini
- SC Malattie Infettive, ASO SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Francesca Patti
- Medical Department, Infectious Diseases Unit, Sanremo Hospital, Imperia, Italy
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, Severe and Immunedepression-Associated Infections Unit, National Institute for Infectious Diseases L. Spallanzani, IRCCS, Rome, Italy
| | - Vincenzo Pota
- Anaesthesia and Intensive Care Unit, Department of Women, Children, General and Specialistic Surgery, L. Vanvitelli University of Campania, Naples, Italy
| | - Francesca Raffaelli
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marianna Rossi
- Clinic of Infectious Diseases, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy
| | - Antonella Santoro
- Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Tascini
- First Division of Infectious Diseases, Cotugno Hospital, AORN dei Colli, Naples, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Department of Medical and Surgical Sciences, Infectious and Tropical Diseases Unit, 'Magna Graecia' University of Catanzaro, Catanzaro, Italy
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Matteo Bassetti
- Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, Infectious Diseases Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Malgorzata Mikulska
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Mario Tumbarello
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
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9
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Zammarchi L, Di Lauria N, Bartalesi F, Suardi LR, Corti G, Mencarini J, Boccolini D, Severini C, Gradoni L, Buonamici C, Garofalo G, Bartolesi AM, Ciccone N, Berni A, Poggesi L, Niccolini F, Rossolini GM, Romi R, Bartoloni A. Cryptic severe Plasmodium falciparum malaria in a Moroccan man living in Tuscany, Italy, August 2018. Euro Surveill 2018; 23:1800527. [PMID: 30326993 PMCID: PMC6194912 DOI: 10.2807/1560-7917.es.2018.23.41.1800527] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In August 2018 a Moroccan man living in Tuscany developed Plasmodium falciparum malaria. The patient declared having not recently visited any endemic country, leading to diagnostic delay and severe malaria. As susceptibility to P. falciparum of Anopheles species in Tuscany is very low, and other risk factors for acquiring malaria could not be completely excluded, the case remains cryptic, similar to other P. falciparum malaria cases previously reported in African individuals living in Apulia in 2017.
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Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Nicoletta Di Lauria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Roberto Suardi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giampaolo Corti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Jessica Mencarini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Daniela Boccolini
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Carlo Severini
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Luigi Gradoni
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | | | | | | | - Nunziata Ciccone
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Andrea Berni
- Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | - Loredana Poggesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Internal Medicine Unit 3, Careggi University Hospital, Florence, Italy
| | | | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Roberto Romi
- Department of Infectious Diseases, National Institute of Health, Rome, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
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10
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Viale P, Scudeller L, Pea F, Tedeschi S, Lewis R, Bartoletti M, Sbrojavacca R, Cristini F, Tumietto F, Di Lauria N, Fasulo G, Giannella M. Implementation of a Meningitis Care Bundle in the Emergency Room Reduces Mortality Associated With Acute Bacterial Meningitis. Ann Pharmacother 2015; 49:978-85. [PMID: 26104050 DOI: 10.1177/1060028015586012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Prompt administration of antibiotics, adjunctive steroid therapy, and optimization of antibiotic delivery to cerebrospinal fluid (CSF) are factors associated with improved outcome of patients hospitalized for acute bacterial meningitis (ABM). However, the impact of a bundle of these procedures has not been reported. OBJECTIVE To assess mortality and neurological sequelae at hospital discharge in a cohort of patients with ABM managed according to a predefined bundle. METHODS Prospective study of all the patients hospitalized for ABM in two provinces of Northern Italy, over two consecutive periods (2005-2009, 2010-2013). The bundle included: i) supportive care if needed; ii) immediate administration of dexamethasone and 3rd generation cephalosporin; and iii) addition of levofloxacin if turbid CSF. Patients managed according to the bundle were compared with a historical group of patients cared for ABM before the bundle was implemented. RESULTS Overall, 85 patients with ABM were managed according to the bundle and were compared with 92 historical controls. In-hospital mortality rates for bundle and control group were 4.7% and 14.1% (p=0.04). Among survivors, 13.5% and 18.9% (p=0.4) of bundle and control-group patients presented neurological sequelae. The only variable associated with mortality at multivariate analysis was ICU admission (HR 3.65). After adjusting for ICU admission, patients managed according with the ABM bundle had significantly lower mortality rate compared to historical controls. CONCLUSIONS Use of a bundled protocol and antibiotics with excellent CSF penetration for the initial management of ABM in emergency department is feasible and associated with significant reduction in mortality.
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Affiliation(s)
- Pierluigi Viale
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Luigia Scudeller
- Clinical Epidemiology and Biostatistics Unit, Scientific Direction, IRCCS Policlinic San Matteo Foundation, Pavia, Italy
| | - Federico Pea
- Institute of Clinical Pharmacology & Toxicology, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Sara Tedeschi
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Russell Lewis
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Rodolfo Sbrojavacca
- Department of Medicine, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Francesco Cristini
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Fabio Tumietto
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Nicoletta Di Lauria
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Giovanni Fasulo
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit - Department of Medical and Surgical Sciences, University of Bologna, Teaching Hospital S. Orsola-Malpighi - Bologna, Italy
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