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Straudi S, Lamberti N, Baluardo L, Spadaro S, Volta CA, Contoli M, Papi A, Passaro A, Libanore M, Gallerani M, Volpato S, Manfredini R, Bergonzoni A, Lavezzi S, Wienand U, Vagnoni E, Manfredini F. From intensive care to rehabilitation: survey on the satisfaction with care received during prolonged hospitalization for COVID-19 at a northern Italian university hospital. Eur Rev Med Pharmacol Sci 2023; 27:11192-11199. [PMID: 38039051 DOI: 10.26355/eurrev_202311_34489] [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: 12/02/2023]
Abstract
OBJECTIVE Investigating the experiences perceived by COVID-19 inpatients is a fundamental research area that is starting to be explored. For this reason, our objective was to provide the first Italian survey on COVID-19 inpatients' satisfaction, obtained through a self-completed questionnaire previously used in a reference study in a UK cohort of COVID-19 patients. SUBJECTS AND METHODS Hospitalized COVID-19 patients (>20 days) admitted to Ferrara University Hospital who underwent rehabilitation during their hospital stay were invited to complete an anonymous questionnaire. The survey's questions explored the patients' satisfaction with the health services received, and their completion took place approximately one year after hospitalization. Information on sex, number of wards, ICU stays, and hospital discharge dates was collected. RESULTS Sixty-two completed questionnaires were analyzed. The average overall satisfaction score obtained from the answers indicated by the participants in the tenth question was 4.7 out of 5.0. Very positive responses were observed for information about discharge plans, privacy, management of pain, sleep quality, and feeling of safety. The possibility of being consulted about medications and side effects received a very low satisfaction score. Considering overall satisfaction, no significant differences were noted for sex or ICU stay. The obtained results were almost superimposable to those reported in the cohort of COVID-19 patients of the reference study. CONCLUSIONS This survey suggested that COVID-19 patients' healthcare satisfaction was high. Nevertheless, some areas must be improved, such as the communication and involvement of the patients in the decision-making of care and the discussion about medications or possible side effects.
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Affiliation(s)
- S Straudi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.
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Capone S, Fusco FM, Milleri S, Borrè S, Carbonara S, Lo Caputo S, Leone S, Gori G, Maggi P, Cascio A, Lichtner M, Cauda R, Dal Zoppo S, Cossu MV, Gori A, Roda S, Confalonieri P, Bonora S, Missale G, Codeluppi M, Mezzaroma I, Capici S, Pontali E, Libanore M, Diani A, Lanini S, Battella S, Contino AM, Piano Mortari E, Genova F, Parente G, Dragonetti R, Colloca S, Visani L, Iannacone C, Carsetti R, Folgori A, Camerini R. GRAd-COV2 vaccine provides potent and durable humoral and cellular immunity to SARS-CoV-2 in randomized placebo-controlled phase 2 trial. Cell Rep Med 2023:101084. [PMID: 37315558 DOI: 10.1016/j.xcrm.2023.101084] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/21/2022] [Revised: 03/21/2023] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and heterologous immunization approaches implemented worldwide for booster doses call for diversified vaccine portfolios. GRAd-COV2 is a gorilla adenovirus-based COVID-19 vaccine candidate encoding prefusion-stabilized spike. The safety and immunogenicity of GRAd-COV2 is evaluated in a dose- and regimen-finding phase 2 trial (COVITAR study, ClinicalTrials.gov: NCT04791423) whereby 917 eligible participants are randomized to receive a single intramuscular GRAd-COV2 administration followed by placebo, or two vaccine injections, or two doses of placebo, spaced over 3 weeks. Here, we report that GRAd-COV2 is well tolerated and induces robust immune responses after a single immunization; a second administration increases binding and neutralizing antibody titers. Potent, variant of concern (VOC) cross-reactive spike-specific T cell response peaks after the first dose and is characterized by high frequencies of CD8s. T cells maintain immediate effector functions and high proliferative potential over time. Thus, GRAd vector is a valuable platform for genetic vaccine development, especially when robust CD8 response is needed.
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Affiliation(s)
| | - Francesco M Fusco
- "D. Cotugno" Hospital, Azienda Specialistica dei Colli, Naples, Italy
| | | | - Silvio Borrè
- ASL Vercelli Malattie Infettive, Vercelli, Italy
| | - Sergio Carbonara
- U.O.C. Malattie Infettive - P.O.V. Emanuele II, Bisceglie (BT), Italy
| | - Sergio Lo Caputo
- Malattie infettive, Dipartimento di Scienze Mediche e Chirurgiche - A.O.U. Policlinico Foggia, Foggia, Italy
| | - Sebastiano Leone
- Division of Infectious Diseases, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Giovanni Gori
- Centro di Farmacologia Clinica per la Sperimentazione dei Farmaci - Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Paolo Maggi
- Università degli Studi della Campania Luigi Vanvitelli, Caserta, Italy
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Miriam Lichtner
- Department NESMOS Sapienza University of Rome, Infectious Disease Unit, SM Goretti Hospital, Latina, Italy
| | - Roberto Cauda
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Maria V Cossu
- I Divisione Malattie Infettive - ASST FBF SACCO, Milan, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Roda
- U.O.C. Malattie Infettive - Fondazione IRCCS Policlinico San Matteo di Pavia, Viale Camillo Golgi, Italy
| | - Paola Confalonieri
- Struttura Complessa Pneumologia - Azienda Sanitaria Universitaria Giuliano-Isontina, Trieste, Italy
| | - Stefano Bonora
- Unit of Infectious Diseases, Department of Medical Sciences, University of Torino, Turin, Italy
| | - Gabriele Missale
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Unit of Infectious Diseases and Hepatology - Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Mauro Codeluppi
- UOC di Malattie Infettive - Ospedale Guglielmo da Saliceto - AUSL Piacenza, Piacenza, Italy
| | - Ivano Mezzaroma
- UOC Malattie Infettive, AOU Policlinico Umberto 1, Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Serena Capici
- Phase 1 Research Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Emanuele Pontali
- Department of Infectious Diseases - E.O. Ospedali Galliera, Genova, Italy
| | - Marco Libanore
- Department Infectious Diseases, Arcispedale Sant'Anna - Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Augusta Diani
- Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | | | - Eva Piano Mortari
- B Cell Unit, Immunology Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale di San Paolo, 00146 Rome, Italy
| | | | | | | | | | | | | | - Rita Carsetti
- B Cell Unit, Immunology Research Area, Bambino Gesù Children's Hospital, IRCCS, Viale di San Paolo, 00146 Rome, Italy
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Vultaggio-Poma V, Sanz JM, Amico A, Violi A, Ghisellini S, Pizzicotti S, Passaro A, Papi A, Libanore M, Di Virgilio F, Giuliani AL. The shed P2X7 receptor is an index of adverse clinical outcome in COVID-19 patients. Front Immunol 2023; 14:1182454. [PMID: 37215142 PMCID: PMC10196164 DOI: 10.3389/fimmu.2023.1182454] [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: 03/08/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction The pathophysiology of the Corona Virus Disease 2019 (COVID-19) is incompletely known. A robust inflammatory response caused by viral replication is a main cause of the acute lung and multiorgan injury observed in critical patients. Inflammasomes are likely players in COVID-19 pathogenesis. The P2X7 receptor (P2X7R), a plasma membrane ATP-gated ion channel, is a main activator of the NLRP3 inflammasome, of the ensuing release of inflammatory cytokines and of cell death by pyroptosis. The P2X7R has been implicated in COVID-19-dependent hyperinflammation and in the associated multiorgan damage. Shed P2X7R (sP2X7R) and shed NLRP3 (sNLRP3) have been detected in plasma and other body fluids, especially during infection and inflammation. Methods Blood samples from 96 patients with confirmed SARS-CoV-2 infection with various degrees of disease severity were tested at the time of diagnosis at hospital admission. Standard haematological parameters and IL-6, IL-10, IL-1β, sP2X7R and sNLRP3 levels were measured, compared to reference values, statistically validated, and correlated to clinical outcome. Results Most COVID-19 patients included in this study had lymphopenia, eosinopenia, neutrophilia, increased inflammatory and coagulation indexes, and augmented sNLRP3, IL-6 and IL-10 levels. Blood concentration of sP2X7R was also increased, and significantly positively correlated with lymphopenia, procalcitonin (PCT), IL-10, and alanine transaminase (ALT). Patients with increased sP2X7R levels at diagnosis also showed fever and respiratory symptoms, were more often transferred to Pneumology division, required mechanical ventilation, and had a higher likelihood to die during hospitalization. Conclusion Blood sP2X7R was elevated in the early phases of COVID-19 and predicted an adverse clinical outcome. It is suggested that sP2X7R might be a useful marker of disease progression.
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Affiliation(s)
| | - Juana Maria Sanz
- Department of Chemical, Pharmaceutic and Agricultural Sciences, University of Ferrara, Ferrara, Italy
| | - Andrea Amico
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Alessandra Violi
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Sara Ghisellini
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Stefano Pizzicotti
- Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
| | - Angelina Passaro
- Laboratory of Clinical Pathology, St. Anna Hospital, Ferrara, Italy
| | - Alberto Papi
- Laboratory of Clinical Pathology, St. Anna Hospital, Ferrara, Italy
| | - Marco Libanore
- Infectious Diseases Unit, St. Anna Hospital, Ferrara, Italy
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Esposito S, Pagliano P, De Simone G, Pan A, Brambilla P, Gattuso G, Mastroianni C, Kertusha B, Contini C, Massoli L, Francisci D, Priante G, Libanore M, Bicocchi R, Borgia G, Maraolo AE, Brugnaro P, Panese S, Calabresi A, Amendola G, Savalli F, Geraci C, Tedesco A, Fossati S, Carretta A, Santantonio T, Cenderello G, Crisalli MP, Schiaroli E, Rovere P, Masini G, Ferretto R, Cascio A, Colomba C, Gioè C, Tumbarello M, Losito AR, Foti G, Prestileo T, Buscemi C, Iaria C, Iacobello C, Sonia S, Starnini G, Ialungo A, Sapienza M. Epidemiology, aetiology and treatment of skin and soft tissue infections: final report of a prospective multicentre national registry. J Chemother 2022; 34:524-533. [DOI: 10.1080/1120009x.2022.2075170] [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: 10/18/2022]
Affiliation(s)
- Silvano Esposito
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Pasquale Pagliano
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Giuseppe De Simone
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Angelo Pan
- Department of Infectious Diseases, Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Paola Brambilla
- Department of Infectious Diseases, Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma Hospital, Mantova, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | - Blertha Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | - Carlo Contini
- Department of Medical Sciences, Section of Infectious Diseases and Dermatology, University of Ferrara, Ferrara, Italy
| | - Lorenzo Massoli
- Department of Medical Sciences, Section of Infectious Diseases and Dermatology, University of Ferrara, Ferrara, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, University Hospital “S. Maria”, University of Perugia, Perugia, Italy
| | - Giulia Priante
- Infectious Diseases Clinic, University Hospital “S. Maria”, University of Perugia, Perugia, Italy
| | - Marco Libanore
- Infectious Diseases Unit, Department of Infectious Diseases, S. Anna University Hospital, Ferrara, Italy
| | - Roberto Bicocchi
- Infectious Diseases Unit, Department of Infectious Diseases, S. Anna University Hospital, Ferrara, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Albert Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Pierluigi Brugnaro
- Infectious Diseases Department, Ospedale Civile “SS. Giovanni e Paolo”, Venice, Italy
| | - Sandro Panese
- Infectious Diseases Department, Ospedale Civile “SS. Giovanni e Paolo”, Venice, Italy
| | - Alessandra Calabresi
- Emergency Department, Hospital “Santi Antonio e Biagio e C. Arrigo”, Alessandria, Italy
| | - Giovanni Amendola
- Emergency Department, Hospital “Santi Antonio e Biagio e C. Arrigo”, Alessandria, Italy
| | | | - Consuelo Geraci
- Infectious Diseases Unit, Hospital of Trapani, Trapani, Italy
| | - Andrea Tedesco
- Infectious Diseases Unit, Hospital Fracastoro San Bonifacio, Verona, Italy
| | - Sara Fossati
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | - Anna Carretta
- Department of Infectious Diseases, University Hospital “Ospedali Riuniti” of Foggia, Foggia, Italy
| | - Teresa Santantonio
- Department of Infectious Diseases, University Hospital “Ospedali Riuniti” of Foggia, Foggia, Italy
| | | | | | - Elisabetta Schiaroli
- Department of Medicine, Section of Infectious Diseases, University of Perugia, Perugia, Italy
| | | | - Giulia Masini
- Infectious Diseases Unit, Legnago Hospital, Verona, Italy
| | - Roberto Ferretto
- Infectious Diseases Unit, “Alto Vicentino” Santorso Hospital, Vicenza, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Claudia Colomba
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Claudia Gioè
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University, Rome, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University, Rome, Italy
| | - Giuseppe Foti
- Infetious Diseases Unit, “Bianchi-Melacrino-Morelli” Hospital, Reggio Calabria, Italy
| | | | | | - Chiara Iaria
- Infectious Diseases Unit, Arnas Civico Hospital, Palermo, Italy
| | | | - Sofia Sonia
- Infectious Diseases Unit, Cannizzaro Hospital, Catania, Italy
| | | | - Anna Ialungo
- Infectious Diseases Unit, Belcolle Hospital, Viterbo, Italy
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5
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Soffritti I, D’Accolti M, Fabbri C, Passaro A, Manfredini R, Zuliani G, Libanore M, Franchi M, Contini C, Caselli E. Oral Microbiome Dysbiosis Is Associated With Symptoms Severity and Local Immune/Inflammatory Response in COVID-19 Patients: A Cross-Sectional Study. Front Microbiol 2021; 12:687513. [PMID: 34248910 PMCID: PMC8261071 DOI: 10.3389/fmicb.2021.687513] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022] Open
Abstract
The human oral microbiome (HOM) is the second largest microbial community after the gut and can impact the onset and progression of several localized and systemic diseases, including those of viral origin, especially for viruses entering the body via the oropharynx. However, this important aspect has not been clarified for the new pandemic human coronavirus SARS-CoV-2, causing COVID-19 disease, despite it being one of the many respiratory viruses having the oropharynx as the primary site of replication. In particular, no data are available about the non-bacterial components of the HOM (fungi, viruses), which instead has been shown to be crucial for other diseases. Consistent with this, this study aimed to define the HOM in COVID-19 patients, to evidence any association between its profile and the clinical disease. Seventy-five oral rinse samples were analyzed by Whole Genome Sequencing (WGS) to simultaneously identify oral bacteria, fungi, and viruses. To correlate the HOM profile with local virus replication, the SARS-CoV-2 amount in the oral cavity was quantified by digital droplet PCR. Moreover, local inflammation and secretory immune response were also assessed, respectively by measuring the local release of pro-inflammatory cytokines (L-6, IL-17, TNFα, and GM-CSF) and the production of secretory immunoglobulins A (sIgA). The results showed the presence of oral dysbiosis in COVID-19 patients compared to matched controls, with significantly decreased alpha-diversity value and lower species richness in COVID-19 subjects. Notably, oral dysbiosis correlated with symptom severity (p = 0.006), and increased local inflammation (p < 0.01). In parallel, a decreased mucosal sIgA response was observed in more severely symptomatic patients (p = 0.02), suggesting that local immune response is important in the early control of virus infection and that its correct development is influenced by the HOM profile. In conclusion, the data presented here suggest that the HOM profile may be important in defining the individual susceptibility to SARS-CoV-2 infection, facilitating inflammation and virus replication, or rather, inducing a protective IgA response. Although it is not possible to determine whether the alteration in the microbial community is the cause or effect of the SARS-CoV-2 replication, these parameters may be considered as markers for personalized therapy and vaccine development.
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Affiliation(s)
- Irene Soffritti
- Section of Microbiology, CIAS Research Center and LTTA, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria D’Accolti
- Section of Microbiology, CIAS Research Center and LTTA, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Chiara Fabbri
- Section of Dentistry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Angela Passaro
- Unit of Internal Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto Manfredini
- Medical Clinic Unit, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giovanni Zuliani
- Unit of Internal Medicine, Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Marco Libanore
- Unit of Infectious Diseases, University Hospital of Ferrara, Ferrara, Italy
| | - Maurizio Franchi
- Section of Dentistry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Carlo Contini
- Section of Infectious Diseases and Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Elisabetta Caselli
- Section of Microbiology, CIAS Research Center and LTTA, Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
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Cultrera R, Barozzi A, Libanore M, Marangoni E, Pora R, Quarta B, Spadaro S, Ragazzi R, Marra A, Segala D, Volta CA. Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings. Int J Environ Res Public Health 2021; 18:ijerph18084358. [PMID: 33923992 PMCID: PMC8073702 DOI: 10.3390/ijerph18084358] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 01/08/2023]
Abstract
Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) with those in a non-COVID-19 ICU from 22 February to 30 April 2020 and in the same period of 2019. We considered blood, urine or respiratory specimens obtained with bronchoalveolar lavage (BAL) or bronchial aspirate (BASP), collected from all patients admitted in ICUs with or without COVID-19 infection. We found a higher frequency of infections due to methicillin-resistant (MR) staphylococci, vancomycin-resistant Enterococcus faecium, carbapenem-resistant Acinetobacter baumannii and Candida parapsilosis in COVID-19-positive patients admitted in ICUs compared to those who were COVID-19 negative. Carbapenem-resistant Pseudomonas aeruginosa was more frequently isolated from patients admitted in non-COVID-19 ICUs. Several conditions favor the increased frequency of these infections by antibiotic-resistant microorganisms. Among all, the severity of the respiratory tracts was definitely decisive, which required assisted ventilation with invasive procedures. The turnover in the ICU of a large number of patients in a very short time requiring urgent invasive interventions has favored the not always suitable execution of assistance procedures. No less important is the increased exposure to infectious risk from bacteria and fungi in patients with severe impairment due to ventilation. The highest costs for antifungal drugs were shown in the ICU-COVID group.
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Affiliation(s)
- Rosario Cultrera
- Infectious Diseases, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-0532239145 or +39-3473628614
| | - Agostino Barozzi
- Clinical Microbiology, Department of Biotechnology, Transfusional and Laboratory, University Hospital of Ferrara, 44124 Ferrara, Italy; (A.B.); (R.P.)
| | - Marco Libanore
- Infectious Diseases Unit, Department of Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Elisabetta Marangoni
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
| | - Roberto Pora
- Clinical Microbiology, Department of Biotechnology, Transfusional and Laboratory, University Hospital of Ferrara, 44124 Ferrara, Italy; (A.B.); (R.P.)
| | - Brunella Quarta
- Pharmacy Service, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.Q.); (A.M.)
| | - Savino Spadaro
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
| | - Riccardo Ragazzi
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
| | - Anna Marra
- Pharmacy Service, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.Q.); (A.M.)
| | - Daniela Segala
- Infectious Diseases, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Carlo Alberto Volta
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
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7
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Bettoli V, Schettini N, Libanore M, Scuderi V, Zedde P, Forconi R, Pacetti L, Ceccherini I, Gattorno M, Poggioli G, Corazza M. The Association among Pyoderma Gangrenosum, Ulcerative Colitis, and Hidradenitis Suppurativa and the Syndromic Hidradenitis Suppurativa Network: A Case Report. Skin Appendage Disord 2021; 7:227-230. [PMID: 34055914 DOI: 10.1159/000513639] [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] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022] Open
Abstract
Hidradenitis suppurativa (HS), together with other inflammatory diseases, is involved in a syndromic network where different combinations of signs and symptoms characterize the definition. The observation of the concurrent occurrence of HS, pyoderma gangrenosum (PG), and inflammatory bowel disease (IBD), in detail ulcerative colitis (UC), led the authors to describe a new association. The patient, a 36-year-old woman, who saw IBD as the first appearing condition, shortly followed by HS and PG, was referred because of a clinical situation quickly worsening. A severe aggravation of both GI symptoms and general systemic situation total led to total colectomy. Surprisingly, shortly after the radical surgical treatment of UC, the cutaneous manifestations of HS and PG with no specific treatment almost completely disappeared suggesting the existence of a common etiopathogenetic mechanism and possibly an inductor role of UC on the other disorders. The presentation of this case offers the opportunity to deal with the fact that the resolution of one of the associated conditions may lead to the clearance of one or more of the others. It confirms a pathogenetic link between them and the pivotal role of one of them, in this case colitis.
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Affiliation(s)
- Vincenzo Bettoli
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Natale Schettini
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Marco Libanore
- Department of Infectious Diseases, St. Anna Hospital and University of Ferrara, Ferrara, Italy
| | - Valeria Scuderi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Pierantonia Zedde
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Riccardo Forconi
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Lucrezia Pacetti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Isabella Ceccherini
- UOSD Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Marco Gattorno
- Clinics of Pediatrics and Rheumatology, G. Gaslini Institute for Children, Geneva, Italy
| | - Gilberto Poggioli
- Digestive Surgery Department, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Monica Corazza
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Cultrera R, Libanore M, Barozzi A, d’Anchera E, Romanini L, Fabbian F, De Motoli F, Quarta B, Stefanati A, Bolognesi N, Gabutti G. Ceftolozane/Tazobactam and Ceftazidime/Avibactam for Multidrug-Resistant Gram-Negative Infections in Immunocompetent Patients: A Single-Center Retrospective Study. Antibiotics (Basel) 2020; 9:E640. [PMID: 32987821 PMCID: PMC7598694 DOI: 10.3390/antibiotics9100640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
Complicated infections from multidrug-resistant Gram-negative bacteria (MDR-GNB) represent a serious problem presenting many challenges. Resistance to many classes of antibiotics reduces the probability of an adequate empirical treatment, with unfavorable consequences, increasing morbidity and mortality. Readily available patient medical history and updated information about the local microbiological epidemiology remain critical for defining the baseline risk of MDR-GNB infections and guiding empirical treatment choices, with the aim of avoiding both undertreatment and overtreatment. There are few literature data that report real-life experiences in the use of ceftolozane/tazobactam and ceftazidime/avibactam, with particular reference to microbiological cure. Some studies reported experiences for the treatment of MDR-GNB infections in patients with hematological malignancies or specifically in Pseudomonas aeruginosa infections. We report our clinical single-center experience regarding the real-life use of ceftolozane/tazobactam and ceftazidime/avibactam to treat serious and complicated infections due to MDR-GNB and carbapenem-resistant Enterobacterales (CRE), with particular regard given to intra-abdominal and urinary tract infections and sepsis.
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Affiliation(s)
- Rosario Cultrera
- Infectious and Tropical Diseases, Department of Morphology, Surgery and Experimental Medicine, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Marco Libanore
- Infectious Diseases Unit, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Agostino Barozzi
- Clinical Microbiology, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (L.R.)
| | - Erica d’Anchera
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Via Fossato Di Mortara 64/B, 44121 Ferrara, Italy; (E.d.); (F.D.M.); (N.B.)
| | - Letizia Romanini
- Clinical Microbiology, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (L.R.)
| | - Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Francesco De Motoli
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Via Fossato Di Mortara 64/B, 44121 Ferrara, Italy; (E.d.); (F.D.M.); (N.B.)
| | - Brunella Quarta
- Department of Pharmacy, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Armando Stefanati
- Public Health Medicine Section, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121 Ferrara, Italy;
| | - Niccolò Bolognesi
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Via Fossato Di Mortara 64/B, 44121 Ferrara, Italy; (E.d.); (F.D.M.); (N.B.)
| | - Giovanni Gabutti
- Public Health Medicine Section, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121 Ferrara, Italy;
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Bettoli V, Manfredini M, Massoli L, Carillo C, Barozzi A, Amendolagine G, Ruina G, Musmeci D, Libanore M, Curtolo A, Mantovani L, Contini C, Pellacani G, Corazza M. Rates of antibiotic resistance/sensitivity in bacterial cultures of hidradenitis suppurativa patients. J Eur Acad Dermatol Venereol 2019; 33:930-936. [PMID: 30394587 DOI: 10.1111/jdv.15332] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Antibiotic (AB) treatment is one of the first steps in the management of hidradenitis suppurativa (HS). Bacteria, in HS patients, may play a double role, as triggering factors of inflammatory reactions and/or agents of infection. OBJECTIVES The aims of this study are as follows: (i) to assess prevalence and AB resistance of bacterial growths in HS patients (ii) assessment of the clinical relevance of obtained data in guiding the selection of the most effective AB therapy. METHODS Purulent material from 137 skin lesions of HS patients was collected with swabs. Bacterial flora and AB sensitivity were determined using microbiological cultures for aerobic and anaerobic bacteria. RESULTS A total of 114 samples resulted positive for bacteria. Sample was collected from the axillae, groin and perianal areas. A total of 163 single bacterial growths were observed; 55% were Gram-positive and 44% were Gram-negative. Among them, 18.4% were anaerobic. The most frequent bacterial families included enterobacteriaceae (30.7%), Staphylococcus (25.2%) and Streptococcus (14.1%). The most frequent genus or species were proteus spp. (13.5%) and Escherichia coli (9.8%). The prevalence of AB resistance observed was clindamycin 65.7%, rifampicin 69.3%, penicillin 70.0%, ciprofloxacin 74%, tetracycline 84.7% and erythromycin 89.0%. A limitation of the study is represented the short culture period adopted which may have impaired the isolation of anaerobes. CONCLUSIONS Bacterial growth in HS patients has shown a high level of resistance to ABs, including rifampicin, clindamycin and tetracyclines, cited as an empiric choice in HS therapeutic guidelines. A targeted and specific AB therapy, driven by microbiological evaluations with prolonged culture periods, seems more appropriate than empiric, generic, non-specific, therapeutic approaches. Current knowledge regarding HS bacterial AB resistance should be considered in the update of current therapeutic guidelines for HS.
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Affiliation(s)
- V Bettoli
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - M Manfredini
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy.,Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - L Massoli
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - C Carillo
- O.U. Microbiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - A Barozzi
- O.U. Microbiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - G Amendolagine
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - G Ruina
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - D Musmeci
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - M Libanore
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - A Curtolo
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - L Mantovani
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
| | - C Contini
- O.U. of Infectious and Tropical Diseases and of the Migrants, University of Ferrara, Ferrara, Italy
| | - G Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine, University of Modena & Reggio Emilia, Modena, Italy
| | - M Corazza
- Department of Medical Sciences, Section of Dermatology, University of Ferrara, Ferrara, Italy
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10
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Esposito S, De Simone G, Pan A, Brambilla P, Gattuso G, Mastroianni C, Kertusha B, Contini C, Massoli L, Francisci D, Priante G, Libanore M, Bicocchi R, Borgia G, Maraolo AE, Brugnaro P, Panese S, Calabresi A, Amendola G, Savalli F, Geraci C, Tedesco A, Fossati S, Carretta A, Santantonio T, Cenderello G, Crisalli MP, Schiaroli E, Rovere P, Masini G, Ferretto R, Cascio A, Colomba C, Gioè C, Tumbarello M, Losito AR, Foti G, Prestileo T, Buscemi C, Chiara I, Iacobello C, Sonia S, Starnini G, Ialungo A, Sapienza M. Epidemiology and Microbiology of Skin and Soft Tissue Infections: Preliminary Results of a National Registry. J Chemother 2018; 31:9-14. [PMID: 30508410 DOI: 10.1080/1120009x.2018.1536320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Skin and soft tissue infections (SSTIs) represent a wide range of clinical conditions characterized by a considerable variety of clinical presentations and severity. Their aetiology can also vary, with numerous possible causative pathogens. While other authors previously published analyses on several types of SSTI and on restricted types of patients, we conducted a large nationwide surveillance programme on behalf of the Italian Society of Infectious and Tropical Diseases to assess the clinical and microbiological characteristics of the whole SSTI spectrum, from mild to severe life-threatening infections, in both inpatients and outpatients. Twenty-five Infectious Diseases (ID) Centres throughout Italy collected prospectively data concerning both the clinical and microbiological diagnosis of patients affected by SSTIs via an electronic case report form. All the cases included in our database, independently from their severity, have been managed by ID specialists joining the study while SSTIs from other wards/clinics have been excluded from this analysis. Here, we report the preliminary results of our study, referring to a 12-month period (October 2016-September 2017). During this period, the study population included 254 adult patients and a total of 291 SSTI diagnoses were posed, with 36 patients presenting more than one SSTIs. The type of infection diagnosed, the aetiological micro-organisms involved and some notes on their antimicrobial susceptibilities were collected and are reported herein. The enrichment of our registry is ongoing, but these preliminary results suggest that further analysis could soon provide useful information to better understand the national epidemiologic data and the current clinical management of SSTIs in Italy.
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Affiliation(s)
- Silvano Esposito
- a Department of Infectious Diseases , University of Salerno , Salerno , Italy
| | - Giuseppe De Simone
- a Department of Infectious Diseases , University of Salerno , Salerno , Italy
| | - Angelo Pan
- b Department of Infectious Diseases , Istituti Ospitalieri of Cremona , Cremona , Italy
| | - Paola Brambilla
- b Department of Infectious Diseases , Istituti Ospitalieri of Cremona , Cremona , Italy
| | - Gianno Gattuso
- c Department of Infectious Diseases , Carlo Poma Hospital , Mantova , Italy
| | - Claudio Mastroianni
- d Department of Public Health and Infectious Diseases , Sapienza University , Latina , Italy
| | - Blerta Kertusha
- d Department of Public Health and Infectious Diseases , Sapienza University , Latina , Italy
| | - Carlo Contini
- e Department of Medical Sciences, Section of Infectious Diseases and Dermatology , University of Ferrara , Ferrara , Italy
| | - Lorenzo Massoli
- e Department of Medical Sciences, Section of Infectious Diseases and Dermatology , University of Ferrara , Ferrara , Italy
| | - Daniela Francisci
- f Infectious Diseases Clinic, University Hospital "S. Maria" , University of Perugia , Perugia , Italy
| | - Giulia Priante
- f Infectious Diseases Clinic, University Hospital "S. Maria" , University of Perugia , Perugia , Italy
| | - Marco Libanore
- g Infectious Diseases Unit, Department of Infectious Diseases , S. Anna University Hospital , Ferrara , Italy
| | - Roberto Bicocchi
- g Infectious Diseases Unit, Department of Infectious Diseases , S. Anna University Hospital , Ferrara , Italy
| | - Guglielmo Borgia
- h Department of Clinical Medicine and Surgery, Section of Infectious Diseases , University of Naples Federico II , Naples , Italy
| | - Alberto Enrico Maraolo
- h Department of Clinical Medicine and Surgery, Section of Infectious Diseases , University of Naples Federico II , Naples , Italy
| | - Pierluigi Brugnaro
- i Infectious Diseases Department , Ospedale Civile "SS. Giovanni e Paolo" , Venice , Italy
| | - Sandro Panese
- i Infectious Diseases Department , Ospedale Civile "SS. Giovanni e Paolo" , Venice , Italy
| | - Alessandra Calabresi
- j Emergency Department , Hospital "Santi Antonio e Biagio e C. Arrigo" , Alessandria , Italy
| | - Giovanni Amendola
- j Emergency Department , Hospital "Santi Antonio e Biagio e C. Arrigo" , Alessandria , Italy
| | | | - Consuelo Geraci
- k Infectious Diseases Unit , Hospital of Trapani , Trapani , Italy
| | - Andrea Tedesco
- l Infectious Diseases Unit , Hospital Fracastoro San Bonifacio , Verona , Italy
| | - Sara Fossati
- m Infectious Diseases Unit , University Hospital of Trieste , Trieste , Italy
| | - Anna Carretta
- n Department of Infectious Diseases , University Hospital "Ospedali Riuniti" of Foggia , Foggia , Italy
| | - Teresa Santantonio
- n Department of Infectious Diseases , University Hospital "Ospedali Riuniti" of Foggia , Foggia , Italy
| | | | | | - Elisabetta Schiaroli
- p Department of Medicine, Section of Infectious Diseases , University of Perugia , Perugia , Italy
| | | | - Giulia Masini
- q Infectious Diseases Unit , Legnago Hospital , Verona , Italy
| | - Roberto Ferretto
- r Infectious Diseases Unit , "Alto Vicentino" Santorso Hospital , Vicenza , Italy
| | - Antonio Cascio
- s Infectious Diseases Unit , Università degli Studi di Palermo , Palermo , Italy
| | - Claudia Colomba
- s Infectious Diseases Unit , Università degli Studi di Palermo , Palermo , Italy
| | - Claudia Gioè
- s Infectious Diseases Unit , Università degli Studi di Palermo , Palermo , Italy
| | - Mario Tumbarello
- t Institute of Infectious Diseases , Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University , Rome , Italy
| | - Angela Raffaella Losito
- t Institute of Infectious Diseases , Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University , Rome , Italy
| | - Giuseppe Foti
- u Infetious Diseases Unit , "Bianchi-Melacrino-Morelli" Hospital , Reggio Calabria , Italy
| | - Tullio Prestileo
- v Infectious Diseases Unit , Arnas Civico Hospital , Palermo , Italy
| | - Calogero Buscemi
- v Infectious Diseases Unit , Arnas Civico Hospital , Palermo , Italy
| | - Iaria Chiara
- v Infectious Diseases Unit , Arnas Civico Hospital , Palermo , Italy
| | | | - Sofia Sonia
- w Infectious Diseases Unit , Cannizzaro Hospital , Catania , Italy
| | - Giulio Starnini
- x Infectious Diseases Unit , Belcolle Hospital , Viterbo , Italy
| | - Anna Ialungo
- x Infectious Diseases Unit , Belcolle Hospital , Viterbo , Italy
| | - Mauro Sapienza
- y UOC Medicina Interna , Ospedale Umberto I , Enna , Italy
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Ciancio G, Sighinolfi L, Furini F, Segala D, Farina I, Galuppi E, De Stefani E, Simone L, Boccia S, Grilli A, Pazzi P, Libanore M, Contini C, Govoni M. Entheseal involvement in asymptomatic human immunodeficiency virus infected patients: preliminary results of a clinical and ultrasonographic study. Clin Exp Rheumatol 2018; 36:862-870. [PMID: 29846159] [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] [Received: 08/04/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES As a strong association between human immunodeficiency virus (HIV) infection and spondyloarthritis (SpA) has been hypothesised, our main objective was to explore by power Doppler ultrasonography (PDUS) the presence of subclinical enthesitis in asymptomatic HIV patients. The presence of subclinical synovitis was also evaluated. METHODS Consecutive asymptomatic HIV patients were studied and compared with asymptomatic HCV patients and healthy controls (HC). All subjects underwent a clinical and PDUS bilateral examination of the following entheses and joints: epicondyle, quadriceps, patellar, Achilles and plantar fascia; wrists, II and III metacarpo-phalangeal, knee and ankle. RESULTS Twenty-nine HIV, 32 HCV and 25 HC were recruited; 1.032 entheses and 860 joints were examined. Clinical diagnosis of enthesitis was made in 10.3% HIV patients, 6.2% HCV patients (p=0.66) and none HC (p=0.24). PDUS enthesitis was found in 72.4% HIV, 28.1% HCV (p=0.0008) and 12% HC (p<0.0001). Clinical diagnosis of synovitis was made in 3.4% HIV patients, 9.3% HCV patients (p=0.61) and none HC (p=1). PDUS abnormalities were documented in 24.1% HIV patients, 71.8% HCV patients (p=0.0003) and none HC (p=0.0001). In detecting enthesitis and synovitis, PDUS was more sensitive than clinical examination both in HIV and HCV patients. CONCLUSIONS Our preliminary study shows the high frequency of PDUS enthesitis in asymptomatic HIV patients, which highlights the close link between HIV and SpA. Further studies are desirable on a larger number of HIV patients to confirm these results. PDUS proved to be more sensitive than clinical examination in detecting subclinical involvement of entheses and joints.
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Affiliation(s)
- Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy.
| | - Laura Sighinolfi
- Infectious Diseases Unit, Department of Infectious Diseases, S.Anna University Hospital, Ferrara, Italy
| | - Federica Furini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Daniela Segala
- Infectious Diseases Unit, Department of Infectious Diseases, S.Anna University Hospital, Ferrara, Italy
| | - Ilaria Farina
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Elisa Galuppi
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Elena De Stefani
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Loredana Simone
- Gastroenterology Unit, Department of Gastroenterology and Digestive Endoscopy, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Sergio Boccia
- Gastroenterology Unit, Department of Gastroenterology and Digestive Endoscopy, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Anastasio Grilli
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Paolo Pazzi
- Gastroenterology Unit, Department of Gastroenterology and Digestive Endoscopy, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Marco Libanore
- Infectious Diseases Unit, Department of Infectious Diseases, S.Anna University Hospital, Ferrara, Italy
| | - Carlo Contini
- Infectious Diseases Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara and S.Anna University Hospital, Ferrara, Italy
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12
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Antonioli P, Formaglio A, Gamberoni D, Bertoni L, Perrone P, Stefanati A, Libanore M, Cultrera R, Gabutti G. Hospital discharge in patients at risk of surgical site infection: antimicrobial stewardship at Ferrara University Hospital, Italy. J Prev Med Hyg 2018; 59:E139-E144. [PMID: 30083621 PMCID: PMC6069401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The appropriate use of antibiotics is a global priority in order to avoid antibiotic resistance. Up to 50% of antibiotics usage in hospital is inappropriate (e.g. prolonged surgical prophylaxis, "defensive medicine" approach). In 2015, at the Ferrara University Hospital, an antimicrobial stewardship intervention to reduce antimicrobial prescription at the time of hospital discharge in patients at risk of surgical site infection was implemented. This programme included: update meetings for health professionals, focused meetings for critical wards, reviews of some surgical prophylaxis protocols, recommendations to reduce broad-spectrum antimicrobials use, and planning of an audit. The purpose of this study has been to evaluate the effect of this antimicrobial stewardship programme. METHODS To evaluate the effect of this intervention, a study has been carried out including inpatients in surveillance for surgical site infection who had surgery during the last quarter of 2014 (pre-intervention group; 461 patients) and of 2015 (post-intervention group; 532 patients). RESULTS The proportion of patients with prescription of at least one antimicrobial at discharge decreased from 33% to 24.4% (p = 0.002). The most prescribed categories of antimicrobials in both groups were the combination of penicillins with beta-lactamase inhibitors (with prescription rate reduced from 21.9% to 18%; p = 0.13) and fluoroquinolones (from 8.2% to 3.2%; p < 0.001). CONCLUSIONS This statistically significant reduction in antimicrobial prescription after the intervention was registered without a change in surgical site infections rate (from 3.5% to 3.2%; p = 0.08). Therefore, this intervention was effective in reducing the antimicrobial prescription at discharge, without affecting patients' safety.
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Affiliation(s)
- P. Antonioli
- Department of Hospital Hygiene & Healthcare Associated Infection Risk Management, Coordination of Clinical Health Promotion Activities, Hospital Health Medical Management, Ferrara University Hospital, Ferrara, Italy
| | - A. Formaglio
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - D. Gamberoni
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - L. Bertoni
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - P. Perrone
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - A. Stefanati
- Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Italy
| | - M. Libanore
- Hospital Infectious Diseases Clinic, Ferrara University Hospital, Ferrara, Italy
| | - R. Cultrera
- University Infectious Diseases Clinic, Ferrara University Hospital, Ferrara, Italy
| | - G. Gabutti
- Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Italy
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Esposito S, Russo E, De Simone G, Gioia R, Petta E, Leone S, Noviello S, Artioli S, Ascione T, Bartoloni A, Bassetti M, Bertelli D, Boccia G, Borrè S, Brugnaro P, Caramello P, Coen M, Crisalli MP, De Caro F, Dodi F, Fantoni M, Foti G, Giacometti A, Leoncini F, Libanore M, Migliore S, Venditti M. Diagnostic and therapeutic appropriateness in bone and joint infections: results of a national survey. J Chemother 2017; 28:191-7. [PMID: 25800800 DOI: 10.1179/1973947815y.0000000012] [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] [Indexed: 10/31/2022]
Abstract
The impact of infectious diseases (ID) specialist consultation in the management of many types of bacterial infections has been fully demonstrated but not for bone and joint infections (BJIs). Nineteen ID Italian centres collected of data from June 2009 to May 2012. Italian guidelines (2009) were used to determine the appropriateness of the diagnostic and therapeutic process of BJIs before and after consulting an ID specialist. Data on 311 patients were collected: 111 cases of prosthetic joint infection, 99 osteomyelitis, 64 spondylodiscitis and 37 fixation device infection. A significant increase of microbiological investigations, imaging techniques and blood inflammation markers were noted after consulting the ID specialist. Moreover, inappropriateness of treatment duration, dosage, and number of administrations significantly decreased after consultation. Infectious disease specialist intervention in the management of BJIs significantly increases the appropriateness both in performing instrumental and laboratory analysis, but especially in determining the correct therapy.
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Affiliation(s)
- Silvano Esposito
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Enrico Russo
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Giuseppe De Simone
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Renato Gioia
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Ester Petta
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Sebastiano Leone
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Silvana Noviello
- a Infectious Diseases Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Stefania Artioli
- b Infectious Diseases Unit , Levante Ligure Hospital, Levante Ligure , Italy
| | - Tiziana Ascione
- c Infectious Diseases Unit , Cotugno Hospital, Naples , Italy
| | - Alessandro Bartoloni
- d Infectious Diseases Unit , University of Florence, Careggi Hospital, Florence , Italy
| | - Matteo Bassetti
- e Infectious Diseases Unit , AOU Santa Maria della Misericordia, Udine , Italy
| | - Davide Bertelli
- f Infectious Diseases Unit , A. O. Spedali Civili, Brescia , Italy
| | - Giovanni Boccia
- g Hygiene Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Silvio Borrè
- h Infectious Diseases Unit , S. Andrea Hospital, Vercelli , Italy
| | - Pierluigi Brugnaro
- i Infectious Diseases Unit , "SS. Giovanni e Paolo" Hospital, Castello, Venice , Italy
| | - Pietro Caramello
- j Infectious Diseases Unit , Amedeo di Savoia Hospital, Turin , Italy
| | - Massimo Coen
- k Infectious Diseases Unit , Sacco Hospital, Milan , Italy
| | | | - Francesco De Caro
- g Hygiene Unit , University of Salerno, San Giovanni di Dio e Ruggi d'Aragona Hospital, Salerno , Italy
| | - Ferdinando Dodi
- m Infectious Diseases Unit , IRCCS San Martino, Genoa , Italy
| | - Massimo Fantoni
- n Infectious Diseases Institute, Catholic S. Cuore, Gemelli Hospital , Rome , Italy
| | - Giuseppe Foti
- o Infectious Diseases Unit , Bianchi Melacrino Morelli Hospital, Reggio Calabria , Italy
| | | | | | - Marco Libanore
- r Infectious Diseases Unit , University of Ferrara, Ferrara , Italy
| | - Simona Migliore
- s Infectious Diseases Unit , Ragusa Hospital, Ragusa , Italy
| | - Mario Venditti
- t Infectious Diseases Institute, University of Rome La Sapienza , Rome , Italy
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Ciancio G, Sghinolfi L, Furini F, Segala D, Farina I, Galuppi E, Bonazzi S, De Stefani E, Libanore M, Govoni M. SAT0544 Entheseal Involvement in Asymptomatic HIV Patients: An Ultrasonographic Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4622] [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: 11/04/2022]
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Libanore M, Merlo R, Borin M, Marchesi E, Rossi MR, Fabbris C, Pelucchi S, Stomeo F, Ciorba A, Malagutti N. Listeria Monocytogenes: an uncommon pathogen of cervical necrotizing fasciitis. B-ENT 2016; 12:245-247. [PMID: 29727131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
The aim of this paper is to present a unique case of neck-necrotizing fasciitis caused by Listeria Monocytogenes in a young woman, successfully treated by surgery and IV antibiotic therapy. Necrotizing fasciitis is a rare, rapidly progressing and potentially life-threatening infection that infrequently occurs in the head and neck region. Pathogens involved in necrotizing fasciitis are heterogeneous and include aerobic and anaerobic bacteria. To the best of our knowledge, this is the only case of neck necrotizing fasciitis caused by Listeria Monocytogenes studied in literature so far.
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Caramori G, Artioli D, Ferrara G, Cazzuffi R, Pasquini C, Libanore M, Guardigni V, Guzzinati I, Contoli M, Rossi R, Rinaldi R, Contini C, Papi A. Severe pneumonia after intravesical BCG instillation in a patient with invasive bladder cancer: case report and literature review. Monaldi Arch Chest Dis 2013; 79:44-8. [PMID: 23741946 DOI: 10.4081/monaldi.2013.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We present here the case of a 66 year old man with a severe bilateral community acquired pneumonia secondary to dissemination after an intravesical instillation of bacilllus Calmette-Guerin (BCG). Diagnosis was based on positive polymerase chain reaction (PCR) for mycobacterium tuberculosis complex in bronchoalveolar lavage and on the finding on transbronchial biopsy of non necrotising granulomas histopathologically similar to the granulomas found in bladder biopsies. These findings were confirmed using a validated real time PCR assay demonstrating the presence of the BCG genome in transbronchial and bladder biopsies.
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Affiliation(s)
- G Caramori
- Sezione di Malattie dell'Apparato Respiratorio, Centro per lo Studio delle Malattie Infiammatorie Croniche delle Vie Aeree e Patologie Fumo Correlate dell'Apparato Respiratorio (CEMICEF), Dipartimento di Scienze Mediche, University of Ferrara, Italy.
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Bovo R, Benatti A, Ciorba A, Libanore M, Borrelli M, Martini A. Pseudomonas and Aspergillus interaction in malignant external otitis: risk of treatment failure. Acta Otorhinolaryngol Ital 2012; 32:416-9. [PMID: 23349563 PMCID: PMC3552534] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 11/12/2011] [Indexed: 10/31/2022]
Abstract
Malignant external otitis (MEO) is a rare infection of the temporal bone primarily affecting elderly patients and diabetics or immunocompromised individuals, which may have dismal prognosis if treatment is not prompt and adequate. Almost 95% of MEO cases reported in the literature are attributed to Pseudomonas aeruginosa, and this pathogen is isolated from aural drainage in > 90% of cases. However, in recent years fungal and polymicrobial temporal bone infections have been reported with increasing frequency. The aim of this paper is to discuss a possible pitfall in MEO treatment using an unusual clinical case. In this patient, bacteriological data positive for Pseudomonas delayed correct diagnosis of Aspergillus infection, which was obtained after surgical debridement and biopsy of the infra-temporal space.
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Affiliation(s)
- R. Bovo
- ENT – Ear Surgery Unit, Az. Ospedaliera Padova, Italy;,Address for correspondence: Roberto Bovo, UOC di ORL-Otochirurgia, Az. Ospedaliera, via Giustiniani 2, 35128 Padova, Italy.
| | - A. Benatti
- ENT – Ear Surgery Unit, Az. Ospedaliera Padova, Italy
| | - A. Ciorba
- Audiology Unit, Ferrara University, Italy
| | - M. Libanore
- Infectious Disease Unit, Ferrara University, Italy
| | - M. Borrelli
- Neuroradiology Unit, Ferrara University, Italy
| | - A. Martini
- ENT – Ear Surgery Unit, Az. Ospedaliera Padova, Italy
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Capuzzo M, Cadorin D, Perna P, Vitali S, Libanore M, Cavazzini L, Alvisi R. West Nile Virus encephalitis in intensive care: a small mosquito, a tremendous danger. Minerva Anestesiol 2011; 77:1224-1227. [PMID: 21597448] [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: 05/30/2023]
Abstract
The authors describe two of three cases of West Nile virus (WNV) meningoencephalitis admitted to ICU in Ferrara (south of Po River) underlying the main common features. They focus on the difficulties in diagnosis, with key-points including seasonality (late summer in Italy), unspecific flu-like symptoms at the beginning, as hyperpyrexia, myalgia and asthenia, followed by neurological impairment, and use of steroids in the patient clinical history. Special attention is deserved to the poor outcome at both short and long term.
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Affiliation(s)
- M Capuzzo
- University Section of Anaesthesiology and Intensive Care, Ferrara University Hospital, Ferrara, Italy.
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Pan A, Gagliotti C, Arlotti M, Bassi P, Bertozzi L, Borsari M, Cancellieri C, Carletti R, Giordani S, Libanore M, Magnani G, Marchegiano P, Mazzini E, Mezzadri S, Minghetti M, Nola S, Puggioli C, Ragni P, Ratti G, Sisti M, Vandelli C, Viale P, Vitali P, Moro ML. Antimicrobial stewardship programs in Emilia-Romagna, Italy. BMC Proc 2011. [PMCID: PMC3239559 DOI: 10.1186/1753-6561-5-s6-p143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Libanore M, Bicocchi R, Pantaleoni M, Ghinelli F. Community-acquired infection due to Stenotrophomonas maltophilia: a rare cause of meningitis. Int J Infect Dis 2004; 8:317-9. [PMID: 15325602 DOI: 10.1016/j.ijid.2004.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2004] [Indexed: 11/18/2022] Open
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Libanore M, Bicocchi R, Pantaleoni M, Antonioli MP, Napoli N, Ghinelli F. [The community-acquired pneumonia: appropriateness of the admissions, risk factors and therapy]. Infez Med 2004; 12:34-43. [PMID: 15329527] [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: 04/30/2023]
Abstract
In a clinical and epidemiological study used Fine's Pneumonia Severity Index to determine the appropriateness of the hospitalisation of patients with community acquired pneumonia in the Internal Medicine Department of a hospital in Northern Italy. Risk factors and antibiotic treatment were checked against recent international guidelines. The study shows that 20% of the admissions were to be not appropriate. The principal risk factors were old age and such the co-morbidities heart failure, chronic cerebral diseases and COPD. In the home setting macrolides are less used than the new fluoroquinolones respirators. In the hospitals arrangements, b-lactams are still highly used, perhaps because of the high percentage of elderly patients. The data currently available suggest that some new fluoroquinolones such as levofloxacin are quite effective, presenting a broad spectrum of action, high bioavailability and good tolerability. Sequential therapy with this antibiotic leads to shorter hospitalisation times.
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Affiliation(s)
- M Libanore
- Dipartimento Medico, Unità Operativa Malattie Infettive, Ferrara, Italy
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De Carlo A, Roda R, Rossi M, Ceruti S, Ghinelli F, Libanore M. [Current epidemiological and clinical features meningitis in a northern Italian area]. Infez Med 2003; 8:167-172. [PMID: 12711895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Objectives: To study etiological, epidemiological and clinical features of 97 cases of acute meningitis. Methods: Ninety-seven cases of acute meningitis were examined in adult HIV-negative patients admitted to the Infectious Diseases Unit of the Azienda Ospedale-Universita S. Anna in Ferrara. Demographic, etiological, epidemiological and clinical data were analyzed. Results: All cases were divided into two groups according to the macroscopic aspect of cerebrospinal fluid (CSF): purulent CSF (50 cases) or non-purulent CSF (47 cases). Purulent CSF meningitis more frequently affected male patients (64% vs 47%) and older patients (average 52 vs 44 years). The main epidemiological features in both groups were underlying bacterial diseases (i.e. otomastoiditis and/or sinusitis in 50% of pneumococcal meningitis) and iatrogenic immunodeficiency. From a clinical point of view the following alterations in the state of consciousness (stupor, confusion and coma) were most frequently found in purulent meningitis. The following non purulent forms of meningitis were diagnosed: 5 tubercular, 3 viral infections, 2 by Listeria monocytogenes, 1 by Entoameba histolytica, 1 by Cryptococcus neoformans and 35 (74,4%) unknown causes. Purulent meningitis were: 20 (40%) Streptococcus pneumoniae, 10 Neisseria meningitidis, 3 Staphylococcus aureus, 2 Escherichia coli, 1 Haemophilus influenzae and 1 Pseudomonas aeruginosa; 13 cases were unidentified. From 1989 to 1993 and from 1994-98 both groups of meningitis increased; respectively from 17 to 30 cases for non-purulent meningitis and from 18 to 32 cases for purulent meningitis. Meningitis due to Streptococcus pneumoniae increased from 27.7% to 46.8% during the period 1994-98. Conclusions: The study shows the high incidence of pneumococcal meningitis, during 1994-98, because a large number of patients with sinusitis and otomastoiditis were observed. The incidence of meningococcal meningitis appears stable. These data confirm the importance of timely diagnosis and correct therapy for such infections with reserved prognosis.
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Affiliation(s)
- A. De Carlo
- Unita Operativa di Malattie Infettive, Unita Operativa di Microbiologia Clinica, Servizio di Neuroradiologia, Azienda Ospedale-Universita S. Anna, Ferrara, Italy
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Corazza M, Ligrone L, Libanore M, Virgili A. Primary cervicofacial nocardiosis due to nocardia asteroides in an adult immunocompetent patient. Acta Derm Venereol 2003; 82:391-2. [PMID: 12430749 DOI: 10.1080/000155502320624230] [Citation(s) in RCA: 9] [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: 10/27/2022] Open
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Abstract
BACKGROUND We studied the prevalence, epidemiological features, symptoms, diagnosis, treatment and outcome of invasive aspergillosis in AIDS patients in Italy. PATIENTS AND METHODS All patients affected by both aspergillosis and AIDS hospitalized between January 1986 and April 1997 (before highly-active antiretroviral therapy, HAART) in four Italian Department of Infectious Disease. Patients were included in the study only if culture, cytology or histology showed firm evidence of Aspergillus infection. Invasive aspergillosis was defined as the presence of characteristic, closely septate hyphae with repeated acute angle branching in either biopsy materials or percutaneous aspirates from tissues other than the lung. Hyphae were identified using hematoxylin-eosin and methenamine silver stain. RESULTS During the study, 54 out of 2,614 patients admitted with AIDS showed aspergillosis (2.1%). The disease usually occurred in patients with < 50 CD4 cells/mm(3). Aspergillosis was associated with neutropenia and steroid treatment. Nonspecific symptoms were frequently encountered. Fever and cough were both present in > 70% of the cases of pulmonary aspergillosis. Biopsy specimens were analyzed for definitive diagnosis. Invasive aspergillosis is usually treated with amphotericin B, but in 90% of the cases this did not prevent death. CONCLUSION In AIDS patients with neutropenia and long-term steroid therapy, it is important to consider invasive aspergillosis in the differential diagnosis of opportunistic infections.
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Affiliation(s)
- M Libanore
- Dept. of Infectious Diseases, St. Anna Hospital and University of Ferrara, C.so Giovecca 203, I-44100 Ferrara, Italy.
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Ghinelli F, Libanore M. [Vector-borne diseases. Recent advances in the diagnosis, treatment and prevention]. Recenti Prog Med 2002; 93:45-57. [PMID: 11851001] [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: 02/23/2023]
Abstract
Vector borne diseases are infections transmitted by arthropods. The vector can mechanically spread the infectious disease or give hospitality to microrganisms for their biological cycle. The etiologic agents of these infections are viruses as yellow fever and Dengue, protozoans as plasmodium of malaria, Leishmania spp., bacteria as Borrelia burgdorferi, Rickettsia spp. or worms as lymphatic filariasis. They are emerging infectious diseases for the epidemiological changes of our national territory (ex. Lyme disease) but especially for the significant increase of the imported forms. Malaria is the more important infection for its clinical management but also for its remote possibility of a further transmission in Italy. In this review are illustrated the recent progresses in the diagnosis, treatment and prevention of the main vector borne infections that the clinical physicians may frequently observe. It is very important to know these diseases because an adequate preparation and continuous updating are necessarily required.
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Affiliation(s)
- Florio Ghinelli
- Unità Operativa Malattie Infettive, Azienda Ospedaliera Universitaria S. Anna, Ferrara.
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Girardi E, Antonucci G, Vanacore P, Libanore M, Errante I, Matteelli A, Ippolito G. Impact of combination antiretroviral therapy on the risk of tuberculosis among persons with HIV infection. AIDS 2000; 14:1985-91. [PMID: 10997404 DOI: 10.1097/00002030-200009080-00015] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [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: 11/25/2022]
Abstract
OBJECTIVE To assess the association between use of different antiretroviral regimens and incidence of tuberculosis among HIV-infected individuals. DESIGN Observational, multicenter, prospective cohort study. SETTING AND PATIENTS Twenty-eight infectious diseases hospital units in Italy. A total of 2160 HIV-infected persons were considered for enrolment in a study on the implementation of tuberculosis preventive therapy between 1 May 1995 and 30 April 1996. The 1360 subjects who completed tuberculin screening at base-line were included in this analysis. Information on the use of antiretroviral therapies over time was collected. The median duration of follow-up was 104 weeks and 997 subjects (73.3%) completed the study. MAIN OUTCOME MEASURE Incidence of active tuberculosis according to different types of antiretroviral therapy. RESULTS Eighteen cases of tuberculosis were observed with an overall incidence rate of 0.79 per 100 person-years of observation [95% confidence interval (CI), 0.51-1.31]. Tuberculin positivity and low CD4+ lymphocyte count were the only base-line variables independently associated with the risk of tuberculosis. During follow-up, 637 patients took double combination antiretroviral therapy and 387 took triple combination therapy. After adjusting for base-line characteristics of enrolled individuals, the relative hazard of tuberculosis was 0.16 (95% CI, 0.03-0.74) for double combination therapy and 0.08 (95% CI, 0.01-0.88) for triple combination therapy compared with no therapy or monotherapy. CONCLUSIONS Combination antiretroviral therapy significantly reduced the risk of tuberculosis in HIV-infected persons. In industrialized countries, the widespread use of this treatment may determine a decrease in the incidence of HIV-associated tuberculosis, possibly contributing to a reduction in the overall incidence of tuberculosis.
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Affiliation(s)
- E Girardi
- Centro di Riferimento AIDS--Servizio di Epidemiologia delle Malattie Infettive, IRCCS L. Spallanzani, Rome, Italy.
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Bonfanti P, Pusterla L, Parazzini F, Libanore M, Cagni AE, Franzetti M, Faggion I, Landonio S, Quirino T. The effectiveness of desensitization versus rechallenge treatment in HIV-positive patients with previous hypersensitivity to TMP-SMX: a randomized multicentric study. C.I.S.A.I. Group. Biomed Pharmacother 2000; 54:45-9. [PMID: 10721462 DOI: 10.1016/s0753-3322(00)88640-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [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: 11/24/2022] Open
Abstract
Our study was undertaken to evaluate if desensitization treatment is more effective than rechallenge in preventing hypersensitivity reactions in HIV-positive patients with previous allergic reactions to TMP-SMX; the secondary aim was to evaluate the frequency of reactions to TMP alone. This was a randomized, multicentre open study. Patients with previous documented hypersensitivity to TMP-SMX who required primary or secondary PCP prophylaxis were enrolled; subjects who had previously had serious adverse reactions to TMP-SMX were excluded. All eligible patients assumed 200 mg TMP for 14 days and in case of no reactions were randomized for desensitization or rechallenge with TMP-SMX. The patients were then followed up by periodical visits for six months. Seventy-three patients were enrolled; 14 subjects (19%) presented reactions on TMP alone during the pre-enrollment phase. The remaining 59 subjects were randomly assigned to the two treatment groups: 34 carried out desensitization (group 1) and 25 rechallenge (group 2) with TMP-SMX. Seven patients in group 1 (20.5%) and seven in group 2 (28%) showed hypersensitivity reactions during treatment; this difference was not statistically significant. No serious reaction occurred in either group. This study showed the comparable effectiveness of the desensitization procedure and rechallenge in patients with a previous, not serious, allergic reaction to TMP-SMX.
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Affiliation(s)
- P Bonfanti
- Ist Dept. of Infectious Diseases and Allergy, L. Sacco Hospital, Milan, Italy
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Arlotti M, Zoboli G, Moscatelli GL, Magnani G, Maserati R, Borghi V, Andreoni M, Libanore M, Bonazzi L, Piscina A, Ciammarughi R. Rhodococcus equi infection in HIV-positive subjects: a retrospective analysis of 24 cases. Scand J Infect Dis 1996; 28:463-7. [PMID: 8953675 DOI: 10.3109/00365549609037941] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rhodococcus equi causes a rare infection in immunocompromised hosts. We describe 24 cases of infection in patients with AIDS-related complex (ARC)/acquired immunodeficiency syndrome (AIDS). Pneumonia was always the first manifestation of R. equi infection, but extrapulmonary involvement was also observed. The main sources of bacteria were sputum, bronchial washings and blood. The strains isolated were mainly susceptible to erythromycin, vancomycin, teicoplanin, rifampicin, imipenem and aminoglycosides. Initial treatment should involve an intravenously administered antibiotic combination therapy including imipenem or vancomycin or teicoplanin, followed by orally administered maintenance combination therapy. Drug combinations should be investigated for serum bactericidal activity in vitro. Surgery does not increase survival time and should only be performed in cases that do not respond to antibiotic treatment. Presumptive risks of infection (contact with horses or farm dust, or cohabiting with people affected by R. equi infection) were present in more than 50% of patients. This finding, and the frequency of bacteria in the sputum, are not sufficient proof of transmission between humans, but do suggest the need for respiratory isolation of patients affected by R. equi pneumonia.
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Affiliation(s)
- M Arlotti
- Division of Infectious Diseases, Rimini Hospital, Italy
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Libanore M, Rossi MR, Pantaleoni M, Bicocchi R, Carradori S, Sighinolfi L, Ghinelli F. Bordetella bronchiseptica pneumonia in an AIDS patient: a new opportunistic infection. Infection 1995; 23:312-3. [PMID: 8557395 DOI: 10.1007/bf01716297] [Citation(s) in RCA: 12] [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: 01/31/2023]
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Libanore M, Pastore A, Frasconi PC, Rossi MR, Bedetti A, Sighinolfi L, Ghinelli F. Invasive multiple sinusitis by Aspergillus fumigatus in a patient with AIDS. Int J STD AIDS 1994; 5:293-5. [PMID: 7948163 DOI: 10.1177/095646249400500414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M Libanore
- Department of Infectious Diseases, St. Anna Hospital, Ferrara, Italy
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Libanore M, Ghinelli F, Gritti FM. Toxoplasma gondii pneumonia in Italian patients infected with HIV. Eur J Epidemiol 1993; 9:233-4. [PMID: 8519364 DOI: 10.1007/bf00158799] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- M Libanore
- Department of Infectious Diseases, St. Anna Hospital, Ferrara, Italy
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Garavelli PL, Libanore M. Blastocystis hominis and blastocystosis (Zierdt-Garavelli disease). Ital J Gastroenterol 1993; 25:33-6. [PMID: 8428021] [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] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- P L Garavelli
- Divisione di Malattie Infettive, Ospedale SS. Antonio e Biagio, Alessandria, Italy
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Fixa B, Komárková O, Krejsek K, Bures J, Nozicka Z, Giorcelli W, Rodi M, Camisasca G, Martinotti RG, Mendall MA, Goggin PM, Molineaux N, Levy J, Toosy T, Strachan D, Northfield TC, Vorobjova T, Vassiljev V, Kisand K, Wadström T, Uibo R, Zotz RB, Xu SG, Recklinghausen GV, Meusers P, Goebell H, Rhee KH, Youn HS, Paik SK, Lee WK, Cho MJ, Park CK, Li Y, Hu P, Du G, Wong Z, Hazell SL, Mitchell HM, Korwin JDD, Remot P, Hartemann P, Catelle A, Conroy MC, Schmitt J, Stolte M, Wellens E, Bethke B, Ritter M, Eidt H, Zanten SVV, Best L, Bezanson G, Marrie T, Poniewierka E, Gosciniak G, Matysiak-Budnik T, Quatrini M, Boni F, Baldassarri AR, Vecchi AD, Castelnovo C, Viganò E, Tenconi L, Bianchi PA, Carlucci A, Ferrini G, Bianco I, Larcinese G, Sciascio AD, Fly GF, Hauge T, Persson J, Coelho LGV, Teixeira MM, Passos MCF, Givisiez CB, Santos CMFR, Rodrigues CJS, Chausson Y, Castro LP, Hyvärinen H, Seppälä K, Kivilaakso E, Kosunen T, Gormse M, Pilotto A, Vianello F, Tornaboni D, Dotto P, Battaglia G, Binda F, Mario FD, Donisi PM, Pasini M, Benve-nuti ME, Stracca-Pansa V, Pasquino M, Jablonowski H, Szelényi H, Hengels KJ, Strohmeyer G, Banatvala N, Mayo K, Megraud F, Jennings R, Deeks JJ, Feldman RA, Bulighin G, Ederie A, Pilati S, Franzin G, Zamboni G, Maran M, Musola R, Tobin A, Hackman RC, McDonald GB, Fatela N, Cristino JM, Monteiro L, Ramalho F, Saragoça A, Salgado MJ, Moura MCD, Pretolani S, Gasbarrini G, Bonvicini F, Baraldini M, Tonelli E, Gatto MRA, Ghironzi GC, égraud FM, Bouchard S, Lubcvzumiska-Kowalska W, Knapik Z, Meenan J, Goggins M, Shahi C, Keeling PWN, Keane C, Weir DG, Vaira D, Miglioli M, Mulè P, Holten J, Menegati M, Biasco G, Vergura M, Nannetti A, Barbara L, Boschini A, Begnini M, Menegatti M, Ghira C, D’Errico A, Evans DG, Asnicar MA, Evans DJ, Graham DY, Lee CH, Coschieri M, Fosse T, Paul MCS, Michiels JR, Delmont JP, Péroux JL, Pradier C, Rampai P, Pazzi P, Merighi A, Gamberini S, Scarliarini R, Bicochi R, Libanore M, Bisi G, Gulllini S. Epidemiology. Ir J Med Sci 1992. [DOI: 10.1007/bf02942891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Libanore M, Bicocchi R, Ghinelli F. Mixed bronchial infection due to Mycobacterium tuberculosis and Mycobacterium avium-intracellulare in an AIDS patient. Infection 1992; 20:298-9. [PMID: 1428188 DOI: 10.1007/bf01710804] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Garavelli PL, Scaglione L, Merighi A, Libanore M. Endoscopy of blastocystosis (Zierdt-Garavelli disease). Ital J Gastroenterol 1992; 24:206. [PMID: 1600197] [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] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- P L Garavelli
- Divisione di Malattie Infettive, Ospedale SS. Antonio e Biagio, Alessandria, Italy
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Libanore M, Bicocchi R, Ghinelli F, Palumbo G, Moretti M, Pazzi P, Scalambra L. Prevalence of antibodies to hepatitis C virus in Italian health care workers. Infection 1992; 20:50. [PMID: 1373408 DOI: 10.1007/bf01704899] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Libanore M, Bicocchi R, Rossi MR, Montanari P, Sighinolfi L, Macario F, Ghinelli F. [Incidence of giardiasis in adults patients with acute enteritis]. Minerva Med 1991; 82:375-80. [PMID: 2067710] [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: 12/30/2022]
Abstract
The Authors report the findings of a perspective study carried out in 214 cases of acute diarrhoea to estimate the presence of giardia intestinalis infections. The incidence of 3.2% has been discussed on the bases of recent epidemiological advances.
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Affiliation(s)
- M Libanore
- Divisione Malattie Infettive, Arcispedale S. Anna, Ferrara
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42
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43
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44
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Garavelli PL, Scaglione L, Libanore M, Rolston K. Blastocystosis: a new disease in patients with leukemia. Haematologica 1991; 76:80. [PMID: 2055567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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45
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Ghinelli F, Sortini A, Pampolini M, Georgacopulo P, Lazzarato M, Sighinolfi L, Libanore M. [Protocol of antibiotic chemoprophylaxis in general surgery]. G Ital Chemioter 1991; 38:67-9. [PMID: 1365614] [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] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- F Ghinelli
- Divisione Malattie Infettive, Arcispedale S. Anna, Ferrara
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46
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Bicocchi R, Libanore M, Carradori S, Catalini MG, Di Giandomenico G, Gritti FM, Ghinelli F. [Effectiveness of and tolerance to intramuscular imipenem in the treatment of infections of different severities]. G Ital Chemioter 1991; 38:177-9. [PMID: 1365584] [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] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- R Bicocchi
- Divisione Malattie Infettive, Arcispedale S. Anna, Ferrara
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47
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Libanore M, Bicocchi R, Pantaleoni M, Montanari P, Singhinolfi L, Ghinelli F. [Teicoplanin in the treatment of Gam-positive bacterial infections in the immunocompromised host]. G Ital Chemioter 1991; 38:167-9. [PMID: 1365581] [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] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- M Libanore
- Divisione Malattie Infettive, Arcispedale S. Anna, Ferrara
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48
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Libanore M, Bicocchi R, Pantaleoni M, Bertoni R, Sighinolfi L, Carradori S, Montanari P, Guidetti B, Bedetti A, Ghinelli F. [Clinico-therapeutic features of pulmonary pneumocystis in the patient with AIDS]. G Ital Chemioter 1991; 38:91-4. [PMID: 1365621] [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] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- M Libanore
- Divisione Malattie Infettive, Arcispedale S. Anna, Ferrara
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49
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Sighinolfi L, Libanore M, Bicocchi R, Reverberi R, Bedetti A, Ghinelli F. Treatment of cerebral malaria by erythrocyte exchange. Recenti Prog Med 1990; 81:804-5. [PMID: 2075285] [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: 12/30/2022]
Abstract
A 33-years-old male presented with a severe malaria, caused by a chloroquine resistant strain of Plasmodium falciparum. The number of parasitized erythrocytes reached 20% and the patient had cerebral complication. During the second hospital day, an erythrocyte exchange was performed as an in addition to chemotherapy. The patient's clinical condition improved and the parasitemia disappeared. The erythrocyte exchange is recommended in severe malaria, when parasitemia greater than 10%, with or without cerebral, renal or blood coagulation complications.
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Affiliation(s)
- L Sighinolfi
- Divisione di Malattie infettive, Arcispedale S. Anna, Ferrara
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50
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Abstract
The protozoon Blastocystis hominis may cause episodes of diarrhoea with abdominal pain, tenesmus, fever and eosinophilia. We have observed 5 cases of blastocystosis in male subjects with symptomatic HIV infection. All patients had a complete response to metronidazole. This report confirms that Blastocystis hominis may be responsible for HIV-related diarrhoea.
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Affiliation(s)
- P L Garavelli
- Department of Infectious Diseases, General Hospital, Alessandria, Italy
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