Amoebic hepatic abscesses in an HIV-positive patient

Antibiotic Abuse and Antimicrobial Resistance in Hospital Environment: A Retrospective Observational Comparative Study

Background and Objectives: Antimicrobial resistance represents a serious problem, and it may be life-threatening in the case of severe hospital-acquired infections (HAI). Antibiotic abuse and multidrug resistance (MDR) have significantly increased this burden in the last decades. The aim of this study was to investigate the distribution and susceptibility rates of five selected bacterial species (E. coli, K. pneumoniae, P. aeruginosa, S. aureus and E. faecium) in two healthcare settings located in the Apulia region (Italy). Materials and Methods: Setting n.1 was a university hospital and setting n.2 was a research institute working on oncological patients. All the enrolled patients were diagnosed for bacterial HAI. The observation period was between August and September 2021. Clinical samples were obtained from several biological sources, in different hospital wards. Bacterial identification and susceptibility were tested by using the software VITEC 2 Single system. Results: In this study, a higher incidence of multi-drug-resistant K. pneumoniae was reported (42,2% in setting n.1 and 50% in setting n.2), with respect to the Italian 2019 statistics report (30.3%). All the isolates of E. faecium and S. aureus were susceptible to linezolid. All the bacterial isolates of P. aeruginosa and most of K. pneumoniae were susceptible to ceftazidime–avibactam. Amikacin and nitrofurantoin represented a good option for treating E. coli infections. Multidrug-resistant (MDR) P. aeruginosa, methicillin-resistant S. aureus (MRSA) and vancomycin-resistantE. faecium (VRE) had a lower incidence in the clinical setting, with respect to E. coli and K. pneumoniae. Conclusions: The data obtained in this study can support clinicians towards a rational and safe use of antibiotics for treating the infections caused by these resistant strains, to enhance the overall efficacy of the current antibiotic protocols used in the main healthcare environments.

Rebalancing the Oral Microbiota as an Efficient Tool in Endocrine, Metabolic and Immune Disorders

The current treatment and prevention procedures of oral disorders follow a very targeted approach considering mouth and its structures as a system that is completely independent, than the rest of the body. The main therapeutic approach is to keep the levels of oral bacteria and hygiene in an acceptable range compatible with oral-mouth health, completely separated from systemic microbial homeostasis (eubiosis vs dysbiosis). This can negatively impact the diagnosis of a more complex systemic disease and its progression. Dysbiosis occurs as a consequence of imbalance in oral and gut microbiota which leads to cardiovascular diseases, diabetes mellitus, rheumatoid arthritis, and Alzheimer's disease, as reported in current literature. Likewise, there is a need to highlight and develop a novel philosophical approach in the treatments for oral diseases that will necessarily involve nonconventional approaches.

Mesenchymal Stem Cells: The Secret Children’s Weapons against the SARS-CoV-2 Lethal Infection

Due to the promising effects of mesenchymal stem cells (MSCs) in the treatment of various diseases, this commentary aimed to focus on the auxiliary role of MSCs to reduce inflammatory processes of acute respiratory infections caused by the 2019 novel coronavirus (COVID-19). Since early in 2020, COVID-19, a consequence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly affected millions of people world-wide. The SARS-CoV-2 infection in children appears to be an unusual event. Despite the high number of affected adult and elderly, children and adolescents remained low in amounts, and marginally touched. Based on the promising role of cell therapy and regenerative medicine approaches in the treatment of several life-threatening diseases, it seems that applying MSCs cell-based approaches can also be a hopeful strategy for improving subjects with severe acute respiratory infections caused by COVID-19.

Management of Endodontic and Periodontal Lesions: the Role of Regenerative Dentistry and Biomaterials

Regenerative dentistry represents a novel interdisciplinary approach involving biomaterials, several molecules and mesenchymal stem cells (MSCs), preferably derived from oral tissues. The pivotal role of MSCs depends on the fact that they can differentiate into different cell lineages and have the strategic role to release bioactive substances that stimulate the renewal and regeneration of damaged tissues. The role of regenerative dentistry is promising in all the branches of dentistry: the most intriguing application is related to the management of endodontic and periodontal defects, overcoming the surgical approach and the implantology as a consequence of a poorly efficient therapeutic plan.

Successful Diagnosis of a Longstanding Giant Amoebic Liver Abscess Using Contrast-Enhanced Ultrasonography (CEUS): A Case Report in a Western Country

BACKGROUND E. histolytica liver abscess results from extra-intestinal diffusion of amebiasis, which is responsible for up 100 000 deaths per annum, placing it second only to malaria in mortality. Currently, the criterion standard for the diagnosis of liver abscesses is ultrasound, but CEUS (contrast-enhanced ultrasound) is emerging as a more accurate method for liver study, and it could be more accurate than ultrasound and non-invasive compared to CT. CASE REPORT A white man (59 years old) with a 2-day history of dyspnea, acute abdominal pain in right upper quadrant, and raised inflammatory markers was admitted to a second-level Emergency Department in Rome (Italy). He reported several trips to tropical areas many years before, during which he ingested non-potable water and became infected with Entamoeba histolytica. This was treated medically with success. After administration of antibiotics (meropenem and metronidazole), a liver CEUS (contrast-enhanced ultrasonography) with administration of SonoVue (sulphur hexafluoride microbubbles) confirmed a giant liver abscess (15×16 cm). One day later, CT-guided drainage was performed without complications and the patient was discharged on the 25th post-procedure day, with improved blood results. CONCLUSIONS Acute abdominal pain can be caused by a variety of diseases, but a diagnosis of parasitic abscess should not be overlooked in non-endemic Western countries. CEUS is a new, promising, and more accurate technique that can be utilized to recognize liver abnormalities, including abscesses; however, retrospective population-wide studies are necessary to define the differential diagnoses.

Multiple Amoebic Liver Abscess As Initial Manifestation in Hiv Sero-Positive Male

Amoebic liver abscess is the most frequent extra-intestinal manifestation of Entamoeba histolytica infection. Immunosuppression is known to predispose to amoebic liver abscess. Although amoebic liver abscess is seen more commonly in patients of Human-Immunodeficiency virus (HIV), first presentation of HIV sero-positive patient as multiple liver abscess is quite uncommon.The author reports an unusual case of multiple liver abscesses in an HIV seropositive patient. This middle aged male with history of multiple unprotected sexual encounters presented with spasmodic abdominal pain, fever, diarrhoea and weight loss along with generalised ill-health and painful liver enlargement. HIV-1 serology was found to be reactive. Imaging revealed an enlarged liver with multiple, irregular, hypoechoic foci characteristic of abscesses. Amoebic aetiology was later confirmed by percutaneous aspiration and microscopy. Administration of appropriate chemotherapeutics along with institution of antiretroviral therapy led to both clinical resolution as well as disappearance of lesions.

Unusual multiple large abscesses of the liver: interest of the radiological features and the real-time PCR to distinguish between bacterial and amebic etiologies

We report a rare case of amebiasis generating 19 large liver abscesses. Such a quantity of abscesses is rare, especially when occurring in a young casual traveler without any immunodeficiency disorders. A possible co-infection was excluded. By contrast, the amebic etiology was confirmed by means of serology and real-time PCR.

Metronidazole treatment for acute phase amoebic liver abscess in patients co-infected with HIV

Metronidazole is the drug of choice for invasive amoebiasis; however, it is not known whether its dose or duration require modification in HIV infection when treating invasive amoebiasis. Seven HIV-positive patients with acute phase amoebic liver abscess were treated with daily oral administration of 1500 mg of metronidazole for 10 days. None of the patients required abscess drainage, and metronidazole was effective in all patients without serious side-effects. The CD4 cell count or HIV viral load did not appear to influence the efficacy of metronidazole therapy.

Clinical significance of enteric protozoa in the immunosuppressed human population

Globally, the number of immunosuppressed people increases each year, with the human immunodeficiency virus (HIV) pandemic continuing to spread unabated in many parts of the world. Immunosuppression may also occur in malnourished persons, patients undergoing chemotherapy for malignancy, and those receiving immunosuppressive therapy. Components of the immune system can be functionally or genetically abnormal as a result of acquired (e.g., caused by HIV infection, lymphoma, or high-dose steroids or other immunosuppressive medications) or congenital illnesses, with more than 120 congenital immunodeficiencies described to date that either affect humoral immunity or compromise T-cell function. All individuals affected by immunosuppression are at risk of infection by opportunistic parasites (such as the microsporidia) as well as those more commonly associated with gastrointestinal disease (such as Giardia). The outcome of infection by enteric protozoan parasites is dependent on absolute CD4(+) cell counts, with lower counts being associated with more severe disease, more atypical disease, and a greater risk of disseminated disease. This review summarizes our current state of knowledge on the significance of enteric parasitic protozoa as a cause of disease in immunosuppressed persons and also provides guidance on recent advances in diagnosis and therapy for the control of these important parasites.

[Immigration and HIV Infection. An approximation to parasitic and viral infections]

Highly-active antiretroviral therapy is effective in reducing opportunistic infections in industrialized countries. However, opportunistic parasitic infections remain the leading cause of HIV-related mortality in developing countries. These infections can also affect HIV-positive immigrants residing in Spain, as well as HIV-infected patients traveling to low-income countries. In addition, immigrants often have viral infections caused by herpesvirus, papillomavirus and polyomavirus, which are closely related to risk behaviors and commercial sex. The present article reviews the characteristics of parasitic and viral infections in patients with HIV infection with the aim of improving understanding of this vulnerable population group.

[Amebic liver abscess: medical treatment or percutaneous aspiration?]

Amebic liver abscess is an emergent disease in Spain due to immigration and travel to endemic countries. Although mainly pharmacological, treatment can sometimes require drainage, especially when there is a high risk of rupture due to location or size. We report a case of amebic liver abscess that, due to its large size and lack of response to metronidazole therapy, required percutaneous drainage. This technique, with ultrasound-guided percutaneous aspiration, would be indicated in lesions with a diameter of > 5 cm, abscesses of the left lobe, and those unresponsive to medical treatment.