[AIDS-related cryptococcosis: diagnostic aspects, prognostic and therapeutic implications]

Diagnostic techniques of AIDS-related cryptococcosis were assessed in a series of 43 HIV-infected patients, and microbiological features were correlated to the clinical course and outcome of disease. Polysaccharide antigen detection was the most sensitive method for central nervous system infection, followed by direct microscopy and culture: in 4 patients this visceral mycosis was initially diagnosed by the detection of isolated cerebrospinal fluid antigen. Thirty-one patients out of 43 suffered from disseminated infection (with positive blood cultures and/or antigenemia). The occurrence of clinical relapses, a lethal outcome, and time to relapses or to death, did not differ significantly between patients with isolated central nervous system and those with disseminated cryptococcosis.

Bacteremia and respiratory involvement by Alcaligenes xylosoxidans in patients infected with the human immunodeficiency virus

Seven cases of Alcaligenes xylosoxidans bacteremia and/or respiratory disease in patients infected with the human immunodeficiency virus (HIV) are described. Reported only thrice previously in this setting, these bacterial complications occurred during different phases of HIV infection and were associated with leukopenia-neutropenia in four patients and a central vascular catheter in two. Although the majority of cases were diagnosed after day 3 of hospitalization, a distinct source of infection was never identified. In four patients with advanced underlying disease, a polymicrobial infection was present. In vitro resistance to aminoglycosides, first-generation cephalosporins, and aztreonam was identified, but treatment with fluoroquinolones, piperacillin, or an aminoglycoside in combination with either ceftazidime or pefloxacin was successful in all cases. The relevance of Alcaligenes xylosoxidans and related species of gram-negative non-glucose fermenting bacilli as opportunistic pathogens in the immunocompromised host and in the setting of HIV infection is briefly reviewed.

[A case report of Listeria monocytogenes infection in a patient with AIDS. Efficacy of treatment with cotrimoxazole associated with rHuG-CSF (filgrastim)]

Listeriosis is an emerging opportunistic infection in the immunocompromised host. A case of sepsis due to Listeria monocytogenes in a patient with advanced HIV infection and severe neutropenia, treated for an underlying non-Hodgkin's lymphoma, is described. Therapy with cotrimoxazole associated with rHuG-CSF (filgrastim) led to a rapidly favourable clinical and microbiological outcome, and to the correction of concurrent neutropenia. The case report is discussed according to a literature review of all cases of listeriosis reported until now in the setting of HIV infection and AIDS. In particular, the role of both cotrimoxazole and rHuG-CSF adjunct in the treatment of listeriosis in the immunocompromised patient is focused.

[Bacteraemia in patients with HIV disease: aetiological spectrum and profile of antimicrobial susceptibility]

A retrospective survey of non-opportunistic bacterial pathogens isolated from blood cultures of patients with HIV disease has been carried out for a 6-year period, and the antibiotic susceptibility of the 748 microorganisms cultured from 682 consecutive patients, has been evaluated. Gram-positive organisms significantly prevailed over gram-negative ones, with Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus faecalis, Xantomonas maltophilia, Salmonella and Pseudomonas sp. as the most common isolates, and Rhodococcus equi, Serratia, Acinetobacter and Alcaligenes sp. as emerging pathogens. Useful suggestions may be obtained for empiric antimicrobial treatment of suspected sepsis in HIV-infected patients, from the evaluation of the antibiotic susceptibility profile of these non-opportunistic bacterial pathogens.

Primary lymph node invasive aspergillosis

A case of apparently primary lymph node granulomatous aspergillosis is described. A review of the so-called primary aspergillosis cases since 1977 shows that granulomatous instead of exudative inflammation patterns have been observed in histological sections only when neither major nor minor predisposing factors have been detected in the clinical history of the patients. A possible pathogenetic role of selectively impaired cell-mediated immune response in these cases is hypothesized. Flucytosine treatment is indicated in a few selected cases of deep aspergillosis.

Morphologic features and clinical significance of skin involvement in patients with AIDS-related cryptococcosis

Eight out of 30 consecutive patients with AIDS and cryptococcal meningoencephalitis (26,7%) presented cutaneous involvement, in the form of papulo-nodular lesions in 3 patients, molluscum contagiosum-like lesions in 3 patients, and pustular-ulcerative lesions in 2 patients. Skin localization represented an untoward prognostic sign, and in 3 out of 8 patients the lesions were diagnosed 2 to 6 weeks before the onset of systemic and neurologic signs and symptoms of the disease. A systematical examination of all suspected cutaneous lesions in subjects with advanced HIV disease may lead to an earlier diagnosis and treatment of disseminated cryptococcosis.

Community-acquired pneumonia due to Staphylococcus cohnii in an HIV-infected patient: case report and review

Coagulase-negative staphylococci recently have been implicated as a cause of serious infections in immunocompromised individuals. An unusual case of community-acquired pneumonia due to Staphylococcus cohnii in an HIV-infected drug user is described. Results of a study conducted to examine the prevalence of infection due to Staphylococcus cohnii strains and their antibiotic-sensitivity patterns show a low frequency but a high morbidity. These results and a brief review of the literature emphasize the importance of these organisms and other staphylococcal species as emerging opportunistic pathogens in patients with AIDS.

Progressive intractable actinomycosis in patients with AIDS

Two rare cases of progressive oropharyngeal actinomycosis, characterized by a subacute and invasive course despite seemingly appropriate antibiotic and surgical treatment, have been observed in patients with AIDS. A brief review of previously reported cases of actinomycosis in HIV-infected patients is presented. Clinical, diagnostic and therapeutic problems dealing with actinomycosis in the immunocompromised host are discussed.

Histoplasmosis capsulati and duboisii in Europe: the impact of the HIV pandemic, travel and immigration

The present report describes a fatal case of imported AIDS-related disseminated histoplasmosis capsulati infection associated with multiple coexisting infections, diagnosed with cultural recovery of Histoplasma capsulatum var. capsulatum with a commercial radiometric Mycobacterium medium. The epidemiological and clinical features of histoplasmosis capsulati and duboisii in Europe are reviewed by examining also 69 documented cases of Histoplasma capsulatum var. capsulatum infection (25 in AIDS patients) and 17 cases of Histoplasma capsulatum var. duboisii infection (3 in HIV-infected patients), described since 1980. This draws special attention to the role played during recent years by the emergence of the HIV pandemic and the progressive intensification of travel and immigration as risk factors for this disease in our continent. AIDS patients, who are prone to multiple concurrent opportunistic infections which may share clinical and laboratory features with each other and with other HIV-associated diseases, represent the most relevant current group at risk for severe disseminated histoplasmosis, which may come to medical attention far from their place of origin.

Histoplasmosis capsulati in Italy: autochthonous or imported?

Reports of a few apparently autochthonous cases of human histoplasmosis and results of epidemiological research suggested the autochthonous presence of the disease in Italy. Identifying two new histologically documented cases of Italian patients, who had never been abroad, and, the positive results of a histoplasmin reactivity survey carried out in the Province of Cremona, Italy confirmed this possibility.

[The incidence, etiology and clinical significance of visceral mycoses in patients with AIDS]

The incidence, aetiology and clinical significance of visceral mycoses in HIV-infected subjects were evaluated by a retrospective survey of the clinical and microbiological records of 237 consecutive AIDS patients followed-up since 1984. Seventy-four patients out of 237 (31.2%) (56 males, 18 females; 55 IV drug abusers, 7 heterosexuals, 6 homobisexuals, 3 blood recipients and 3 children with congenitally-acquired HIV infection) presented 77 different episodes of visceral fungal infection as a whole, represented by candidiasis in 56 cases (oesophageal 45, pulmonary 5, sepsis 2, eye involvement 2, endocarditis and invasive oropharyngeal infection in the remaining 2 patients), cryptococcosis in 17 cases (meningoencephalitis in all subjects, with disseminated infection in 11 of them), and aspergillosis in 4 cases (pulmonary 2, cerebral and cranio-facial in the remaining 2 patients). In 57 out of 74 patients (77%), visceral mycoses were diagnostic or concurrent with the diagnosis of AIDS. Fungal diseases, as a whole, showed a significantly higher incidence (p < 0.03) among drug abusers, whereas homobisexual men presented a significantly lower frequency (p < 0.001, chi-square test) than AIDS patients with other risk factors for HIV infection. The onset of cryptococcosis was significantly associated with the male sex (p < 0.005, Fisher exact test). All subjects suffering from a visceral mycosis were severely immunosuppressed, with a higher rate of neutropenia in patients developing Candida and Aspergillus spp. infection (23 out of 56 patients with visceral candidiasis and 3 out of 4 cases of aspergillosis had an absolute neutrophil count lower than 1500 cells/mm3), while a severe reduction in CD4+ lymphocyte count was more evident among patients with cryptococcosis (13 out of 17 patients had a CD4+ cell count lower than 50/mm3). After remission of the primary episode of fungal infection (obtained in 80.5% of cases), the incidence of relapse observed in a long follow-up period (mean time 57.6 +/- 39.2 weeks) was elevated both for patients with cryptococcosis (7 cases out of 17) and subjects with candidiasis (19 cases out of 53), with no significant difference among patients receiving a secondary prophylaxis or not (22 relapses observed in 53 patients treated with maintenance antifungals versus 4 episodes in 8 patients followed for a comparable mean time with no antimycotic treatment). Fifty-two out of 74 patients (70.3%) have died up to now; in 21 of them death was due to or associated with the visceral mycosis (cryptococcosis in 11 cases, candidiasis in 8, aspergillosis in 2).(ABSTRACT TRUNCATED AT 400 WORDS)

Relationship between Candida albicans and denture stomatitis: a clinical and microbiological study

A study was done on 52 upper denture wearers, randomly selected among the residents of two nursing-homes. The results show that the prevalence of Candida albicans in the denture is significantly higher than that in the mucosa. It was also possible to establish a significant relationship between the clinical patterns and the microbiological findings. A healthy mucosa does not present C. albicans, whereas a diffuse denture stomatitis more often presents the yeast both in the mucosa and in the denture. Finally, diffuse erythema is correlated to continuous denture-wearing, while there is not significant correlation between healthy mucosa and type I denture stomatitis and denture-wearing habits.

Inactivation of ribosomes by an inhibitor of protein synthesis from Salmonella enteritidis

Sonic extracts of Salmonella enteritidis contain a factor which inhibits protein synthesis in cell-free systems by irreversibly inactivating ribosomes. The extent of the inactivation of ribosomes depends on the system used to assay protein synthesis, natural mRNA translation being more strongly inhibited than poly(U) translation. The inhibitory power of the Salmonella factor is destroyed by trypsin and by 5% mercaptoethanol. Placental RNase inhibitor is unable to protect ribosomes from inactivation.

Absence of HTLV-I/II infection in blood donors with positive and inconclusive HTLV-I/II serology

The pathogenetic potential and the true extent of human T leukemia/lymphotropic virus type I (HTLV-I) and type II (HTLV-II) infection are unknown. To find out more about HTLV-I/II seroepidemiology and the risks of iatrogenic transmission, we performed a serological study, screening 4086 healthy blood donors. A surprisingly high percentage of serum reactivity to HTLV-I/II antigens was observed by commercial ELISA (2.08%) and immunoblotting (IB) (0.85%) analysis, although none of the samples satisfied the (IB) criteria for positivity based on detection of gag protein p24 and at least one env gene product, either gp46 or gp61/68. To clarify these inconclusive results, we performed polymerase chain reaction (PCR) analysis for HTLV-I and HTLV-II provirus detection in peripheral blood lymphocytes, obtained from individuals with an apparent pattern of seropositivity. The data obtained by PCR failed to reveal evidence of HTLV-I/II provirus integration in peripheral blood cells, ruling out the possibility of a viral infection in these cases, and pinpointing the limitations of both serological methods used. Our observations suggest that serological assays alone are not a reliable tool for blood donor screening of HTLV-I/II infection and raise the important question of interpreting inconclusive results.

Keratomycosis with an unusual etiology (Rhodotorula glutinis): a case report

A case of deep keratomycosis with isolation of Rhodotorula glutinis is discussed. Keratoplasty, done immediately, prevented panophthalmitis and cured the patient. The etiology and pathogenesis of fungal keratitis is examined.

A case study of atypical allergic bronchopulmonary aspergillosis confirmed by endobronchial biopsy

A case of allergic bronchopulmonary aspergillosis without asthmatic attacks is described. An endobronchial biopsy established the diagnosis, and also highlighted histological aspects suggestive of a mechanism of humoral immunity for the pathogenesis of the disease process.

In vitro comparison of the activity of cefotaxime and desacetylated cefotaxime and of their combination

The activity of cefotaxime (CTX), desacetylcefotaxime (dCTX) and their combinations (CTX and dCTX in a 1:1 ratio) was tested against a variety of aerobic and anaerobic bacteria collected from clinical specimens. The in-vitro tests demonstrated that CTX is still active against a wide range of clinically interesting microorganisms. The interaction of CTX and dCTX was shown to be additive at subinhibitory and inhibitory concentrations for Enterobacteriaceae. The most significant increase in the antibacterial activity was seen against Bacteroides strains: 29% of 62 strains were sensitive to CTX and 38% to CTX plus dCTX.

Isolation of an inhibitor of cell-free protein synthesis from Salmonella enteritidis

Sonic extracts of Salmonella enteritidis, serotype enteritidis, contain a factor which inhibits eukaryotic cell-free protein synthesis tested on a rabbit reticulocyte lysate system and on a poly(U)-dependent system from Artemia salina embryos. The factor is heat-labile, does not diffuse through dialysis bags and is precipitated by ammonium sulphate. A 78% recovery of the factor was obtained in the 60-80 per cent ammonium sulphate saturation range, with a 3.3-fold purification. The factor binds to DEAE-cellulose. In the fraction eluted at 0.55 M NaCl, SDS-polyacrylamide gel electrophoresis shows only two protein bands (Mr 55,000 and 29,000). While the inhibitory activity on protein synthesis of the crude factor is fairly stable at 4 degrees C, it becomes very labile after DEAE-cellulose chromatography. The ID50 of the partially purified factor was less than 0.55 microgram (20-fold purification).

Salmonella serotypes isolated from gastroenteritis patients and healthy carriers in northern Italy. A twelve years retrospective study

Salmonella serotypes isolated from 33,306 patients with acute gastroenteritis over a 12 years period (1975-1986) and Salmonella serotypes isolated from 19,381 healthy individuals in the last three years (1984-1986) are reported. The Salmonella serotypes isolated most frequently from gastroenteric patients are poorly represented among the serotypes present in healthy individuals. These data suggest that Salmonella serotypes involved in human pathology in the area examined are not of human origin and presumably arise from food animals.

Incidence of endogenous and exogenous opportunistic fungal infections in relation to different prophylactic measures: clinical and microbiological study of 431 immunocompromised patients

Two groups of immunocompromised patients were studied with the aim of pointing out the possibilities of antifungal prophylaxis in this type of patient. All patients received oral treatment with nystatin, but only the patients of one group were also in strict reverse isolation. It has been confirmed that chemoprophylactic treatments may control opportunistic endogenous mycoses effectually. On the contrary, only reverse isolation seems to be effective against airborne exogenous fungal infections. Because of the difficulty and high cost of this practice, different modalities for a really generalizable antifungal prophylaxis are required. At present only the detection of new systemic antifungal drugs, which are not toxic and are easy to use, seems hopeful.

Limits of antifungal prophylaxis by ketoconazole in leukemic patients

Serum ketoconazole levels in leukemic patients, subjected to ketoconazole prophylaxis, were determined by an agar diffusion assay. High individual variability of drug concentration was noted. In addition, the highest drug concentration observed was less than 1 microgram/ml in 5 out of 6 patients studied. The reliability of prophylaxis of airborne opportunistic fungal infections by ketoconazole seems, therefore, to be hampered, at least in leukemics, by the too low serum concentrations of the drug. The bioassay proved to be highly reproducible and accurate as well as easy and safe to perform.

A two-year longitudinal study on the etiology of acute diarrhea in young children in Northern Italy

During a 24-month period, 561 young children (6 months-2 years of age) hospitalized for acute diarrhea were studied for enteric pathogens. Patients positive for one or more pathogens were 359 (64.0%). Infection with one pathogen was found in 266 (47.4%) patients, whereas multiple infection was detected in 93 (16.6%) patients. Enteropathogens associated with disease were Rotaviruses: 150 (26.7%), Adenoviruses: 99 (17,6%), non-polio Enteroviruses: 48 (8.5%), Coronaviruses: 10 (1.8%), Parvoviruses: 5 (0.9%), Salmonella sp.: 41 (7.3%), Campylobacter fetus: 45 (8.0%), Giardia lamblia: 8 (1.4%), and "enteropathogenic" E. coli: 63 (11.2%) of which 15 (3%) produced heat labile enterotoxin. Seasonal occurrence of enteropathogens is also described.

[Research on substances with antiviral activity. VIII. Benzindanoncarboxylic acids]

New derivatives (esters, amides, nitriles, amidines, thiosemicarbazones and guanylhydrazones) of 1H-benz[e]indene-2,3-dihydro-5-methyl-1-oxo-3-carboxylic acid and 1H-benz[e]indene-2,3-dihydro-7-methyl-3-oxo-1-carboxylic acid were prepared and tested for antiviral activities in vitro against vaccinia virus, HID stock and parainfluenza type 3 virus, HA-I/CR-8 stock. Four compounds (II g), (II i), (III b), (III g), showed weak activity in vitro against vaccinia virus.

Drug resistance and plasmid mediated transfer of drug resistance in Escherichia coli isolated from various districts of the human organism. A possible relationship with the antimicrobial drug concentrations during therapy

The study of the prevalence of drug resistances and of the frequency of R factors among resistant strains, in E. coli isolated respectively from the respiratory, intestinal and urinary tracts of patients, during 1976, has shown that the frequency of drug resistances is highest among E. coli strains isolated from the respiratory tract and lowest among the E. coli strains isolated from urines. The frequency of R factors, among resistant strains, follows an exactly opposite distribution. This behaviour could be related to the gradient of antimicrobial drug concentrations achieved in the various compartments during ordinary antimicrobial therapy.

[Research on substances with antiviral activity. VII. Activity and lipophilic of property N-alkyl-2-chloro-3-formylindole thiosemicarbazone]

Thiosemicarbazones of N-alkyl-2-chloroindole-3-carboxaldehydes were synthesized and investigated for antiviral activity against RNA virus (parainfluenza type 3, HA-I/CR-8 stock) and DNA virus (vaccinia virus, HID stock). The effect of lipophilicity on the activity against vaccinia virus was considered. Relative lipophilicities were measured by a reversed phase thin-layer chromatographic technique. The most active compound N-isopropyl-2-chloroindole-3-carboxaldehyde thiosemicarbazone appeared comparable for its activity to methisazone.