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Antonelli A, Coppi M, Bonaiuto C, Giovacchini N, Vaggelli G, Farese A, Pollini S, Rossolini GM. Novel resistance ICEs carrying the blaFIM-1 metallo-β-lactamase gene from an ST235 Pseudomonas aeruginosa sublineage. Antimicrob Agents Chemother 2024; 68:e0120523. [PMID: 38206043 PMCID: PMC10848763 DOI: 10.1128/aac.01205-23] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024] Open
Abstract
FIM-1 is an acquired metallo-β-lactamase identified in a multidrug-resistant Pseudomonas aeruginosa (index strain FI-14/157) of clinical origin isolated in 2007 in Florence, Italy. Here we report on a second case of infection by FIM-1-positive P. aeruginosa (FI-17645), which occurred in 2020 in the same hospital. Both FIM-1-positive strains exhibited resistance to all anti-Pseudomonas antibiotics except colistin and cefiderocol. Comparative genomic characterization revealed that the two FIM-positive strains were closely related [core genome difference, 16 single nucleotide polymorphisms (SNPs)], suggesting a local circulation of similar strains. In the FI-14/157 index strain, the blaFIM-1 gene was associated with an ISCR19-like element that likely contributed to its capture downstream an integron platform inserted aboard a Tn21-like transposon, named Tn7703.1, which was associated with a large integrative and conjugative element (ICE) named ICE7705.1, integrated into an att site located within the 3'-end of tRNAGly CCC gene of the P. aeruginosa chromosome. In strain FI-17645, blaFIM-1 was associated with a closely related ICE, named ICE7705.2, integrated in the same chromosomal site. Similar ICE platforms, lacking the blaFIM-1-containing region, were detected in other ST235 P. aeruginosa strains from different geographic areas, suggesting a common ancestry and underscoring the role of these elements in the dissemination of resistance genes in P. aeruginosa. Sequence database mining revealed two draft P. aeruginosa genomes, one from Italy and one from the USA (both isolated in 2012), including a contig with blaFIM-1, suggesting that this resistance gene could have a broader distribution than originally anticipated.
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Affiliation(s)
- Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Chiara Bonaiuto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Nicla Giovacchini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Guendalina Vaggelli
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Alberto Farese
- Infectious and Tropical Diseases Unit, Florence Careggi University Hospital, Florence, Italy
| | - Simona Pollini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
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Gallinoro V, Grazzini M, Paolini D, Dannaoui B, Farese A, Mantengoli E, Ipponi A, Pieralli F, Bonaccorsi G, Niccolini F. Information technology systems to support antimicrobial stewardship programs. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Problem
Inappropriate antibiotic use contributes to the emergence and spread of multidrug-resistant organisms that are responsible for life-threatening infections. Furthermore, overprescription of antibiotics is associated with an increased risk of adverse effects and higher costs.
Description of the problem
Careggi is a tertiary care teaching hospital in Italy, with nearly 1,200-bed units, involved since 2015 in antimicrobial stewardship (AMS) programs. Despite implementation programs, carbapenems (CAR) consumption rates remained higher than the national average; for this reason, the AMS hospital team started a project aimed at improving the appropriateness of this type of drug.
Results
The project started in October 2021 and involved 10 hospital Units selected as the major prescribers of CAR. The strategies were planned by a multi-professional and multi-disciplinary team of experts in AMS and were set in place by a multimodal approach focused on information technology (IT) functions implemented in the electronic medical record such as:
• time-out alerts at 72 hours inviting physicians to evaluate if the prescribed antimicrobial is still warranted or effective against the identified organism(s);
• interactive and customizable prescribing algorithms to support physicians in empirical and targeted therapies;
• electronic dashboards viewable by physicians and the AMS team to daily monitor and review CAR prescriptions.
These functions were complemented by a series of training sessions for prescribing physicians aimed to promote a more rational and appropriate antimicrobials use. Six months after the project began, an overall reduction in the prescription of CAR was observed: from 6.2 DDD/100 patient-days to 4.9 DDD/100 patient-days.
Lessons
AMS programs use different interventions to influence the behavior of prescribers toward more appropriate use of antimicrobials. IT functions represent complementary and useful tools to promote antimicrobial stewardship programs.
Key messages
• Antimicrobial stewardship programs aim at optimizing antibiotic use and reducing inappropriate antibiotic prescriptions.
• Information technology systems represent useful tools within AMS programs.
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Affiliation(s)
- V Gallinoro
- School of Specialization in Public Health, University of Florence , Florence, Italy
| | - M Grazzini
- Health Direction, Careggi University Hospital , Florence, Italy
| | - D Paolini
- Health Direction, Careggi University Hospital , Florence, Italy
| | - B Dannaoui
- Computerization of Healthcare Processes Unit, Careggi University Hospital , Florence, Italy
| | - A Farese
- Infectious and Tropical Diseases Unit, Careggi University Hospital , Florence, Italy
| | - E Mantengoli
- Infectious and Tropical Diseases Unit, Careggi University Hospital , Florence, Italy
| | - A Ipponi
- Pharmacy Department, Careggi University Hospital , Florence, Italy
| | - F Pieralli
- High Intensity Internal Medicine Unit, Careggi University Hospital , Florence, Italy
| | - G Bonaccorsi
- Department of Health Sciences, University of Florence , Florence, Italy
| | - F Niccolini
- Health Direction, Careggi University Hospital , Florence, Italy
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3
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Coppi M, Antonelli A, Niccolai C, Bartolini A, Bartolini L, Grazzini M, Mantengoli E, Farese A, Pieralli F, Mechi MT, Di Pilato V, Giani T, Rossolini GM. Nosocomial outbreak by NDM-1-producing Klebsiella pneumoniae highly resistant to cefiderocol, Florence, Italy, August 2021 to June 2022. Euro Surveill 2022; 27:2200795. [PMID: 36305334 PMCID: PMC9615416 DOI: 10.2807/1560-7917.es.2022.27.43.2200795] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 09/29/2023] Open
Abstract
A nosocomial outbreak by cefiderocol (FDC)-resistant NDM-1-producing Klebsiella pneumoniae (NDM-Kp) occurred in a large tertiary care hospital from August 2021-June 2022 in Florence, Italy, an area where NDM-Kp strains have become endemic. Retrospective analysis of NDM-Kp from cases observed in January 2021-June 2022 revealed that 21/52 were FDC-resistant. The outbreak was mostly sustained by clonal expansion of a mutant with inactivated cirA siderophore receptor gene, which exhibited high-level resistance to FDC (MIC ≥ 32 mg/L) and spread independently of FDC exposure.
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Affiliation(s)
- Marco Coppi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Claudia Niccolai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Bartolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Laura Bartolini
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Maddalena Grazzini
- Hospital Infection Prevention and Control Unit, Florence Careggi University Hospital, Florence, Italy
| | - Elisabetta Mantengoli
- Hospital Infection Prevention and Control Unit, Florence Careggi University Hospital, Florence, Italy
- Infectious and Tropical Diseases Unit, Florence Careggi University Hospital, Florence, Italy
| | - Alberto Farese
- Infectious and Tropical Diseases Unit, Florence Careggi University Hospital, Florence, Italy
| | - Filippo Pieralli
- Subintensive Care Unit, Florence Careggi University Hospital, Florence, Italy
| | - Maria Teresa Mechi
- Hospital Infection Prevention and Control Unit, Florence Careggi University Hospital, Florence, Italy
| | - Vincenzo Di Pilato
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
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4
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Tumbarello M, Raffaelli F, Cascio A, Falcone M, Signorini L, Mussini C, De Rosa FG, Losito AR, De Pascale G, Pascale R, Giacobbe DR, Oliva A, Farese A, Morelli P, Tiseo G, Meschiari M, Del Giacomo P, Montagnani F, Fabbiani M, Vargas J, Spanu T, Bassetti M, Venditti M, Viale P. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac022. [PMID: 35265842 PMCID: PMC8900192 DOI: 10.1093/jacamr/dlac022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/15/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives To explore the real-life performance of meropenem/vaborbactam for treating serious KPC-producing Klebsiella pneumoniae infections, including those resistant to ceftazidime/avibactam. Methods A retrospective observational cohort study was conducted in 12 Italian hospitals. Enrolled patients had K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) infections (59.5% of which were ceftazidime/avibactam resistant). Patients who received ≥72 h of meropenem/vaborbactam therapy (with or without other antimicrobials) in a compassionate-use setting were included. Results The 37 infections (all hospital-acquired) were mainly bacteraemic (BSIs, n = 23) or lower respiratory tract infections (LRTIs, n = 10). Clinical cure was achieved in 28 (75.6%) cases and microbiologically confirmed in all 25 with follow-up cultures. Three (10.7%) of the 28 clinical cures (all BSIs, 2/3 microbiologically confirmed) were followed by in-hospital recurrences after meropenem/vaborbactam was discontinued (median interval: 18 days). All three recurrences were susceptible to meropenem/vaborbactam and successfully managed with meropenem/vaborbactam combined with colistin or fosfomycin. Nine patients (24.3%) (all with BSIs or LRTIs) died in hospital with persistent signs of infection. Most were aged over 60 years, with high comorbidity burdens and INCREMENT scores ≥8. Only one had received meropenem/vaborbactam monotherapy. Six began meropenem/vaborbactam therapy >48 h after infection onset. Outcomes were unrelated to the isolate’s ceftazidime/avibactam susceptibility status. The single adverse event observed consisted of severe leukopenia with thrombocytopenia. Conclusions With the well-known limitations of real-life retrospective studies, our results support previous findings indicating that meropenem/vaborbactam therapy will be a safe, effective tool for managing serious KPC-Kp infections, including the increasing proportion displaying resistance to ceftazidime/avibactam.
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Affiliation(s)
- Mario Tumbarello
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
- Corresponding author. E-mail: ;
| | - Francesca Raffaelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127, Palermo, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Liana Signorini
- UOC Malattie Infettive, Spedali Civili di Brescia, Brescia, Italy
| | - Cristina Mussini
- Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy
| | | | - Angela Raffaella Losito
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Gennaro De Pascale
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Roma, Italy
- Dipartimento di Scienze dell’emergenze, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Renato Pascale
- Dipartimento scienze mediche e chirurgiche, Università di Bologna/IRCCS Policlinico Sant’Orsola, Bologna, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Scienze della Salute (DISSAL), Università di Genova, Genova, Italy
| | - Alessandra Oliva
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy
| | - Alberto Farese
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Paola Morelli
- Infectious Diseases Unit, Hospital Health Direction, Humanitas Clinical and Research Center – IRCCS, Rozzano, Milan, Italy
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Milan, Italy
| | - Giusy Tiseo
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Meschiari
- Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia, Modena, Italy
| | - Paola Del Giacomo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Francesca Montagnani
- Dipartimento di Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Massimiliano Fabbiani
- UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Joel Vargas
- Dipartimento di Scienze dell’emergenze, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Teresa Spanu
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Dipartimento di Scienze dell’emergenze, anestesiologiche e della rianimazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Matteo Bassetti
- Clinica Malattie Infettive, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Scienze della Salute (DISSAL), Università di Genova, Genova, Italy
| | - Mario Venditti
- Dipartimento di Sanità Pubblica e Malattie Infettive, Università Sapienza, Roma, Italy
| | - Pierluigi Viale
- Dipartimento scienze mediche e chirurgiche, Università di Bologna/IRCCS Policlinico Sant’Orsola, Bologna, Italy
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5
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Piccica M, Basile G, Bartalesi F, Parenti G, Farese A, Buci L, Corti G, Bartoloni A, Peri A. Tolvaptan efficacy and drug-drug interactions. MINERVA ENDOCRINOL 2020; 45:264-265. [PMID: 32272825 DOI: 10.23736/s0391-1977.20.03189-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Matteo Piccica
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gregorio Basile
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Bartalesi
- Unit of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Gabriele Parenti
- Unit of Pituitary Diseases and Sodium Alterations, Department of Endocrinology, Careggi University Hospital, Florence, Italy
| | - Alberto Farese
- Unit of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Lisa Buci
- Unit of Pituitary Diseases and Sodium Alterations, Department of Endocrinology, Careggi University Hospital, Florence, Italy
| | - Giampaolo Corti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Infectious and Tropical Diseases, Careggi University Hospital, Florence, Italy
| | - Alessandro Peri
- Pituitary Disease and Sodium Alterations Unit, Department of Endocrinology, University of Florence, AOU Careggi, Florence, Italy -
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6
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Lagi F, Ottino L, Mantengoli E, Distefano A, Corti G, Farese A, Dannaoui B, Ipponi A, Falai T, Rossolini GM, Bartoloni A, Bartalesi F. Early discharge criteria in patients with acute bacterial skin and skin structure infections in a large tertiary-care teaching hospital in Florence, Italy. Eur J Clin Microbiol Infect Dis 2019; 38:1781-1785. [PMID: 31222396 PMCID: PMC6695376 DOI: 10.1007/s10096-019-03609-9] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/04/2019] [Indexed: 12/15/2022]
Abstract
The study is aimed at retrospectively estimating the percentage of inpatients with severe acute bacterial skin and skin structure infections (ABSSSI) who met the early discharged (ED) criteria adapted from Nathwani et al. (Int J Antimicrob Agents. 2016 Aug;48(2):127-36) and to calculate the number of hospitalization days that could be potentially saved. A retrospective study was conducted in a tertiary care hospital in Florence, Italy. We included all patients admitted for cellulitis and post-surgical infections from 2014 to 2017. Demographic and clinical data were obtained from electronic medical records. We a priori defined the following as a risk factor for non-adherence (RFNA): active or on methadone intravenous drug users, homeless, migrants without health care assistance, and patients who need a caregiver to take prescribed medications. One hundred sixty-two subjects were enrolled. Of them, 94 (58.0%) were male, and 113 (69.7%) had cellulitis/erysipelas. A microbiological isolate was obtained in 51 patients (31.4%); Staphylococcus aureus was the most frequent (47%). Eighty-four (51.8%) were ED suitable, with 258 (49.0%) patient days potentially saved. Among the 78 not ED suitable patients, the most common reason for prolonged length of stay (LOS) was having at least one RFNA (34.6%). Fourteen (18.0%) had one RFNA. Half of the patients admitted in our hospital met the ED criteria with a sparing close to 50% in terms of hospitalization days. Unstable social and personal factors were the most frequent causes for prolonged LOS. In this selected subset of patients, more recent and easier to administer treatments, including long-acting agents, could be proposed.
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Affiliation(s)
- Filippo Lagi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Letizia Ottino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Alberto Distefano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giampaolo Corti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Farese
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Bassam Dannaoui
- Health Direction, Careggi University Hospital, Florence, Italy
| | - Alessandra Ipponi
- Hospital Pharmacy and Pharmaceutical Policies, Careggi University Hospital, Florence, Italy
| | - Tiziana Falai
- Hospital Pharmacy and Pharmaceutical Policies, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Filippo Bartalesi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
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7
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Pieralli F, Baroncelli S, Farese A, Mancini A, Luise F, Sammicheli L, Bartoloni A, Rossolini GM, Nozzoli C. Every cloud has a silver lining. Intern Emerg Med 2017; 12:811-815. [PMID: 28493028 DOI: 10.1007/s11739-017-1675-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 04/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Filippo Pieralli
- Intermediate Care Unit, Careggi University Hospital, Largo Brambilla, 3, 50141, Florence, Italy
| | - Silvia Baroncelli
- Intermediate Care Unit, Careggi University Hospital, Largo Brambilla, 3, 50141, Florence, Italy.
| | - Alberto Farese
- Infectious Diseases Clinic, Careggi University Hospital, Florence, Italy
| | - Antonio Mancini
- Intermediate Care Unit, Careggi University Hospital, Largo Brambilla, 3, 50141, Florence, Italy
| | - Fabio Luise
- Intermediate Care Unit, Careggi University Hospital, Largo Brambilla, 3, 50141, Florence, Italy
| | - Lucia Sammicheli
- Intermediate Care Unit, Careggi University Hospital, Largo Brambilla, 3, 50141, Florence, Italy
| | | | - Gian Maria Rossolini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
- Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Carlo Nozzoli
- Emergency and Internal Medicine Department, Careggi University Hospital, Florence, Italy
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8
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Boyode BP, Sinet M, Farese A, Forestier-Roux MA, Condom R, Ayi IA, Kirn A, Moog C, Guedj R. Synthesis and Antiviral Evaluation of Fluorinated Dipyridodiazepinones and Dipyridodiazepines (Nevirapine Derivatives). ACTA ACUST UNITED AC 2016. [DOI: 10.1177/095632029500600305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The synthesis of trifluoromethyldipyridodiazepinones, which are analogues of nevirapine, one of the non-nucleoside inhibitors of the HIV-1 RT enzyme, is described. The condensation of 3-amino-2-chloro-4-tri-fluoromethyl pyridine with 2-chloronicotinoyl chloride followed by a cyclization with cyclopropylamine provided the corresponding trifluoromethylated dipyridodiazepinone. Similarly, the dipyridodiazepine analogues were synthesized by condensation of 3-amino-2-chloro-4-trifluoromethylpyridine with the O-mesyl derivative of 2-chloro-3-pyridincarbinol followed by reaction with cyclopropylamine. The inhibitory effect of these compounds on the HIV-1-induced cytopathic effect in MT4 cells has been evaluated.
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Affiliation(s)
- B. P. Boyode
- Laboratoire de Chimie Bio-Organique, Université de Nice-Sophia Antipolis, Faculté des Sciences, Parc valrose B.P. 71, F-06108 Nice Cedex, France
| | - M. Sinet
- Inserm, U74, Institut de Virologie, 3, rue Koeberlé, 67000 Strasbourg, France
| | - A. Farese
- Laboratoire de Chimie Bio-Organique, Université de Nice-Sophia Antipolis, Faculté des Sciences, Parc valrose B.P. 71, F-06108 Nice Cedex, France
| | - M.-A. Forestier-Roux
- Laboratoire de Chimie Bio-Organique, Université de Nice-Sophia Antipolis, Faculté des Sciences, Parc valrose B.P. 71, F-06108 Nice Cedex, France
| | - R. Condom
- Laboratoire de Chimie Bio-Organique, Université de Nice-Sophia Antipolis, Faculté des Sciences, Parc valrose B.P. 71, F-06108 Nice Cedex, France
| | - I. A. Ayi
- Laboratoire de Chimie Bio-Organique, Université de Nice-Sophia Antipolis, Faculté des Sciences, Parc valrose B.P. 71, F-06108 Nice Cedex, France
| | - A. Kirn
- Inserm, U13, ancien Hôpital Claude Bernard, 190, Bd McDonald, 75019 Paris, France
| | - C. Moog
- Inserm, U13, ancien Hôpital Claude Bernard, 190, Bd McDonald, 75019 Paris, France
| | - R. Guedj
- Laboratoire de Chimie Bio-Organique, Université de Nice-Sophia Antipolis, Faculté des Sciences, Parc valrose B.P. 71, F-06108 Nice Cedex, France
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9
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Magurano F, Zammarchi L, Baggieri M, Fortuna C, Farese A, Benedetti E, Fiorentini C, Rezza G, Nicoletti L, Bartoloni A. Chikungunya from the Caribbean: the importance of appropriate laboratory tests to confirm the diagnosis. Vector Borne Zoonotic Dis 2016; 15:258-60. [PMID: 25897812 DOI: 10.1089/vbz.2014.1724] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 11/12/2022] Open
Abstract
Chikungunya virus (CHIKV) appeared for the first time in the Western Hemisphere--the French West Indies--in December of 2013. From there, the virus has spread to other Caribbean islands. Following the diagnosis of first autochthonous CHIKV cases in the Caribbean island of Saint Martin, a large outbreak is ongoing in the Americas. As of September 12, 2014, a total of 706,093 suspected and 9803 confirmed CHIKV cases have been reported in the Americas. This case study highlights the possibility of false-negative immunochromatographic CHIKV immunoglobulin M (IgM) tests and the need of confirmatory tests for suspected cases. Moreover, a greater spread of virus together with the presence of a mosquito vector (Aedes albopictus) enhances the risk of autochthonous transmission in Europe.
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Affiliation(s)
- Fabio Magurano
- 1 Department of Infectious, Parasitic and Immune-Mediate Diseases, Istituto Superiore di Sanità , Rome, Italy
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10
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Zammarchi L, Antonelli A, Lapini M, Prato M, Farese A, Rossolini GM, Bartoloni A. Travelers lowering their guard: a bacterial, viral and protozoan co-infection after a five-day journey in India. J Travel Med 2016; 23:taw044. [PMID: 27378368 DOI: 10.1093/jtm/taw044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/31/2016] [Indexed: 11/13/2022]
Abstract
We present a case of concurrent infections by Campylobacter jejuni, Giardia intestinalis and Hepatitis E virus acquired during a 5-days travel to India by an Italian traveller : Professionals responsible for pre- and post-travel care should underline food and water precautions and prescribe an adequate diagnostic work-up in symptomatic patients.
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Affiliation(s)
- Lorenzo Zammarchi
- Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy.,SOD Malattie Infettive E Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alberto Antonelli
- Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy
| | - Manuela Lapini
- SOD Microbiologia E Virologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Marco Prato
- Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy
| | - Alberto Farese
- SOD Malattie Infettive E Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Gian Maria Rossolini
- Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy.,SOD Microbiologia E Virologia, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.,Dipartimento Di Biotecnologie Mediche, Università Di Siena, Italy.,I.R.C.C.S. Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Alessandro Bartoloni
- Dipartimento Di Medicina Sperimentale E Clinica, Università Di Firenze, Florence, Italy.,SOD Malattie Infettive E Tropicali, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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11
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Lagi F, Zammarchi L, Strohmeyer M, Bartalesi F, Mantella A, Meli M, Blanc P, Tacconi D, Farese A, Zanelli G, Pippi F, Aquilini D, Tonziello A, Nencioni C, Benvenuti M, Moneta S, Furnari F, Ciufolini MG, Nicoletti L, Bartoloni A. Imported dengue fever in Tuscany, Italy, in the period 2006 to 2012. J Travel Med 2014; 21:340-3. [PMID: 25155927 PMCID: PMC4309477 DOI: 10.1111/jtm.12144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 06/30/2014] [Accepted: 07/07/2014] [Indexed: 11/26/2022]
Abstract
This report focuses on epidemiological and clinical features of dengue fever (DF) in Tuscany (Italy) between 2006 and 2012. Sixty-one DF cases were diagnosed, 32 of which were in the period of Aedes albopictus activity. Some clinical (arthralgia/myalgia, nausea/vomiting, and skin rash), laboratory (leukopenia and thrombocytopenia), and epidemiological characteristics (travel in a continent other than Africa) significantly distinguished DF cases from other febrile illnesses. Our data stress the importance of increasing awareness on dengue in Italy among clinicians in order to reach an early diagnosis in returning travelers and to implement appropriate clinical and public health interventions.
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Affiliation(s)
- Filippo Lagi
- Clinica Malattie Infettive, Università di Firenze, Firenze, Italy
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12
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Lerma F, MacVittie T, Farese A, Wang Z, Amin P. SU-FF-T-484: Late Survival Post Acute Total Body Irradiation in the Rhesus Macaque With Bone Marrow Sparing. Med Phys 2009. [DOI: 10.1118/1.3181982] [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: 11/07/2022] Open
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13
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Lerma F, Liu B, Wang Z, Yu C, Yi B, Koshy M, Farese A, Macvittie T. SU-GG-J-140: Online Re-Planning Using Direct Machine Parameter Optimization: A Non-Human Primate Lung Irradiation Study. Med Phys 2008. [DOI: 10.1118/1.2961689] [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: 11/07/2022] Open
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14
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O'Neal L, Hsu K, MacVittie T, Farese A, Gilbert M. Sargramostim (Leukine®/GM-CSF) for Autologous (Au) or Allogeneic (Allo) Bone Marrow Transplant (BMT) Engraftment Delay or Failure (ED/F) After Total Body Irradiation Conditioning (TBI). Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.07.169] [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: 10/22/2022]
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Abstract
The introduction of highly active antiretroviral therapy in 1995 dramatically decreased AIDS-related events and deaths rates; however, the enthusiasm among the medical and social community was soon limited by the growing incidence of various side-effects that often greatly limited patients' quality of life. The second problem caused by such a complex treatment consisted of sub-optimal adherence, with a consequent higher risk of the development of drug resistance.
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van Leth F, Conway B, Laplumé H, Martin D, Fisher M, Jelaska A, Wit FW, Lange JMA, Laplumé H, Lasala MB, Losso MH, Bogdanowicz E, Lattes R, Krolewiecki A, Zala C, Orcese C, Terlizzi S, Duran A, Ebensrteijn J, Bloch M, Russell O, Russell DB, Roth NR, Eu B, Austin D, Gowers A, Quan D, Demonty J, Peleman R, Vandercam B, Vogelaers D, van der Gucht B, van Wanzeele F, Moutschen MM, Badaro R, Grinsztejn B, Schechter M, Uip D, Netto EN, Coelho SS, Badaró F, Pilotto JH, Schubach A, Barros ML, Leite OHM, Kiffer CRV, Wunsch CT, Nunes D, Catalani A, de Cassia Alves LR, Dossin TJ, D'Alló de Oliveira MT, Martini S, Conway B, de Wet JJ, Montaner JSG, Murphy C, Woodfall B, Sestak P, Phillips P, Montessori V, Harris M, Tesiorowski A, Willoughby B, Voigt R, Farley J, Reynolds R, Devlaming S, Livrozet JM, Rozenbaum W, Sereni D, Valantin MA, Lascoux C, Milpied B, Brunet C, Billaud E, Huart A, Reliquet V, Charonnat MF, Sicot M, Esnault JL, Slama L, Staszewski S, Bickel M, Lazanas MK, Stavrianeas N, Mangafas N, Zagoreos I, Kourkounti S, Paparizos V, Botsi C, Clarke S, Brannigan E, Boyle N, Chiriani A, Leoncini F, Montella F, Francesco L, Ambu S, Farese A, Gargiulo M, Di Sora F, Lavria F, Folgori F, Beniowski M, Boron Kaczmarska A, Halota W, Prokopowicz D, Bander DB, Leszuzyszyn-Pynka MLP, Wnuk AW, Bakowska E, Pulik P, Flisiak R, Wiercinska-Drapalo A, Mularska E, Witor A, Antunes F, Sarmento RSE, Doroana M, Horta AA, Vasconcelos O, Andrews SM, Huisamen CB, Johnson D, Martin O, Bekker LG, Maartens G, Wilson D, Visagie CJ, David NJ, Rattley M, Nettleship E, Martin DJ, Keyser V, Moraites TM, Moorhouse MA, Pitt JA, Orrell CJ, Bester C, Parboosing R, Moodley P, Gathiram V, Woolf D, Bernasconi E, Magenta L, Cardiello P, Kroon E, Ungsedhapand C, Fisher M, Wilkins EGL, Stockwell E, Day J, Daintith RS, Perry N, Timaeus C, Intosh-Roffet JM, Powell A, Youle M, Tyrer M, Madge S, Drinkwater A, Cuthbertson Z, Carroll A, Becker S, Katner H, Rimland D, Saag MS, Thompson M, Witt M, Aguilar MM, LaVoy A, Illeman M, Guerrero M, Gatell J, Belsey E, Hirschel B, Potarca A, Cronenberg M, Kreekel L, Meester R, Khodabaks J, Botma HJ, Esrhir N, Farida I, Feenstra M, Jansen K, Klotz A, Mulder M, Ruiter G, Bass CB, Pluymers E, de Vlegelaer E, Leeneman (VCL) R, Carlier H, van Steenberge E, Hall D. Quality of Life in Patients Treated with First-Line Antiretroviral Therapy Containing Nevirapine And/Or Efavirenz. Antivir Ther 2004. [DOI: 10.1177/135965350400900512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To assess whether differences in safety profiles between nevirapine (NVP) and efavirenz (EFV), as observed in the 2NN study, translated into differences in ‘health related quality of life’ (HRQoL). Design A sub-study of the 2NN study, with antiretro-viral-naive patients randomly allocated to NVP (once or twice daily), EFV or NVP+EFV, in addition to stavudine and lamivudine. Methods Comparing differences in changes of HRQoL over 48 weeks as measured with the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire, using analysis of variance. Results The 2NN study enrolled 1216 patients. No validated questionnaires were available for 244 patients, and 55 patients had no HRQoL data at all, leaving 917 patients eligible for this sub-study. A total of 471 (51%) had HRQoL measurements both at baseline and week 48. The majority (69%) of patients without HRQoL measurements did, however, complete the study. The change in the physical health score (PHS) was 3.9 for NVP, 3.4 for EFV and 2.4 for NVP+EFV ( P=0.712). For the mental health score (MHS) these values were 6.1, 7.0 and 3.9, respectively ( P=0.098). A baseline plasma HIV-1 RNA concentration (pVL) ≥100 000 copies/ml and a decline in pVL (per log10) were independently associated with an increase of PHS. An increase of MHS was only associated with pVL decline. Patients experiencing an adverse event during follow-up had a comparable change in PHS but a significantly smaller change in MHS, compared with those without an adverse event. Conclusions First-line ART containing NVP and/or EFV leads to an improvement in HRQoL. The gain in HRQoL was similar for NVP and EFV, but slightly lower for the combination of these drugs.
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Affiliation(s)
| | - Frank van Leth
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Brian Conway
- University of British Columbia, Vancouver, BC, Canada
| | - Hector Laplumé
- Hospital Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Des Martin
- Toga Laboratories, Edenvale, South Africa
| | - Martin Fisher
- Brighton and Sussex University Hospitals, Brighton, UK
| | - Ante Jelaska
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn., USA
| | - Ferdinand W Wit
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joep MA Lange
- International Antiviral Therapy Evaluation Center (IATEC); Department of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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17
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Martinelli C, Farese A, Carocci A, Giorgini S, Tortoli E, Leoncini F. First case of Mycobacterium haemophilum infection in an AIDS patient in Italy. J Eur Acad Dermatol Venereol 2004; 18:83-5. [PMID: 14678539 DOI: 10.1111/j.1468-3083.2004.00781.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mycobacterium haemophilum, a strongly acid- and alcohol-fast bacillus belonging to the group of non-tuberculous mycobacteria was first described in 1978 as the cause of cutaneous ulcerating lesions in a woman with Hodgkin's disease. Infection due to M. haemophilum is rare but increasing in prevalence in immnunosuppressed subjects, particularly in patients with acquired immunodeficiency syndrome (AIDS) patients. The skin is the most common site of infection with erythematous or violaceous papules and/or nodules that are usually painless at first, but some elements develop into abscesses or ulcers that can become very painful. The incidence of M. haemophilum is unknown, but cases of infection have been reported in Australia, Canada, the United States, France, Israel, the United Kingdom and Taiwan; to date no cases have been reported in Italy, thus the case reported here is apparently the first one observed in our country.
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Affiliation(s)
- C Martinelli
- Infectious Diseases Unit, Microbiology Unit, Azienda Ospedaliera Careggi, Viale Pieraccini 17, 50139 Florence, Italy.
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18
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Poliakova L, Pirone A, Farese A, MacVittie T, Farney A. Presence of nonhematopoietic side population cells in the adult human and nonhuman primate pancreas. Transplant Proc 2004; 36:1166-8. [PMID: 15194404 DOI: 10.1016/j.transproceed.2004.04.058] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Side population (SP) cells defined by their ability to efflux Hoechst dye 33342 (Hst), demonstrate functional stem cell capabilities in adult murine tissues and may represent organ-specific stem cells. We examined adult human (Hu) and rhesus macaque (Rh) pancreatic tissue for the presence of SP cells. METHODS Hu cadaver (n = 4) and Rh donor (n = 5) pancreata were dispersed with collagenase and separated by density gradient centrifugation to relatively enrich fractions for islet, ductal, and acinar tissue in human and islet and nonislet tissue in Rh. Single cell suspensions were incubated with varying Hst concentrations to determine optimal conditions for SP cell analysis. Cellular heterogeneity was assessed using a panel of monoclonal antibodies positive for hematopoietic and/or endothelial cells. RESULTS Hu SP cells comprised approximately 0.12%, 0.08%, and 0.45% of the gated populations for Hu islet, ductal, and acinar fractions respectively. In Rh, 5.5% and 3.7% of the islet and nonislet fractions were identified as SP cells. FACS analysis of Hu pancreas-derived SP cells indicated that greater than 95% were CD45(-), and only 6% were CD34(+)CD45(-). A similar phenotype was detected in Rh pancreas-derived SP cell populations: greater than 70% were CD45(-) and less than 2% were endothelial lineage positive. CONCLUSIONS SP cells are found in both islet- and nonislet-enriched fractions of the adult Hu and Rh pancreas. The majority of pancreatic SPs are CD45(-) and CD34(-), suggesting nonhematopoietic lineage. Further preclinical study is needed to establish the phenotype and functional role of adult tissue-specific versus tissue-resident stem cells.
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Affiliation(s)
- L Poliakova
- University of Maryland, Greenebaum Cancer Center, Baltimore, 21201, USA
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Bartoloni A, Strohmeyer M, Bartalesi F, Messeri D, Tortoli E, Farese A, Leoncini F, Nutini S, Righi R, Gabbuti A, Mazzotta F, Paradisi F. Evaluation of a rapid immunochromatographic test for the serologic diagnosis of tuberculosis in Italy. Clin Microbiol Infect 2003; 9:632-9. [PMID: 12925103 DOI: 10.1046/j.1469-0691.2003.00574.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/20/2022]
Abstract
OBJECTIVE To determine specificity, sensitivity and predictive values of a rapid immunochromatographic assay (ICT tuberculosis) for the diagnosis of tuberculosis (TB) in an Italian clinical setting, and to identify tentative new guidance for the interpretation of test results. METHODS The ICT tuberculosis test is an immunochromatographic test based on the detection of IgG antibodies directed against five highly purified antigens secreted by Mycobacterium tuberculosis during active growth. Sera from 60 patients with active pulmonary (48 sputum smear-positive and six sputum smear-negative cases) and extrapulmonary (six cases) TB were obtained. Personal, anamnestic and clinical data were investigated and recorded for each patient. The control groups comprised 156 subjects: 40 healthy individuals, half of them Mycobacterium bovis BCG-vaccinated, and 116 patients with mycobacterial diseases other than TB (five cases), with nonmycobacterial lung diseases (30 cases), with nonmycobacterial nonlung diseases (30 cases), with nonmycobacterial diseases and rheumatoid factors positivity (30 cases), and with asymptomatic HIV infection (21 cases). For 21 individuals the test was simultaneously performed with both serum and whole blood sample. Each positive result of the ICT test was reported with regard to the number (1-4), position (A, B, C, D) and color intensity (+ to ++++) of the evidenced lines in order to assess the quality of the antibody response. RESULTS The overall sensitivity and specificity were 56.7% and 90.4%, respectively. The sensitivity for pulmonary TB patients was 61.1% (66.7% for smear-positive and 16.7% for smear-negative cases) and 16.7% for extrapulmonary TB patients. The difference between ICT results in pulmonary TB patients and control subjects was statistically significant (P < 0.0001). The analysis of the positive ICT tests revealed that samples with strong color intensity (>/=++) and specific antibodies bound to antigens immobilized on line D were significantly more frequent in TB patients than in controls (P = 0.001 and P= 0.027, respectively). ICT test results with the presence of at least three visible lines were more often observed in the TB patients than in controls, although not reaching statistical significance (P = 0.052). No difference was observed between the results of the ICT test performed both on serum and whole blood sample. CONCLUSIONS The ICT tuberculosis test was confirmed to be rapid and easy to perform without requiring special equipment, both on serum and whole blood sample. Our data, in accordance with those obtained in a previous study conducted in extra-European countries, confirmed higher sensitivities for the smear-positive TB patients than for the smear-negative TB patients, and for pulmonary TB patients than for the extrapulmonary TB patients. Data obtained on the quality of antibody response in the ICT positive samples, might be used to improve the performance of the test.
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Affiliation(s)
- A Bartoloni
- Clinica di Malattie Infettive, Università degli Studi di Firenze, Firenze, Italia.
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Martinelli C, Farese A, Mistro AD, Giorgini S, Ruffino I. Resolution of recurrent perianal condylomata acuminata by topical cidofovir in patients with HIV infection. J Eur Acad Dermatol Venereol 2001; 15:568-9. [PMID: 11843219 DOI: 10.1046/j.1468-3083.2001.00288.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/20/2022]
Abstract
Anogenital condylomata acuminata are the most frequent clinical manifestation of genital human papillomavirus (HPV) infection. Association between human immunodeficiency virus (HIV) and HPV infections is frequent (range: 26-60% in males). Topical cidofovir (a nucleotide analogue antiviral drug active against a broad range of DNA viruses) is a potential treatment for anogenital warts in immunocompromised patients. We treated three HIV-infected patients with HPV perianal condylomas with topical 1% cidofovir in flexible collodion once a day for 2 weeks. The treatment resulted in complete clearance of the HPV lesions. The patients experienced mild transient erythema without any other side-effects. None of the patients relapsed during the 10-14-month follow-up period.
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Affiliation(s)
- C Martinelli
- Infectious Diseases Unit, Azienda Ospedaliera Careggi, Florence, Italy.
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Bartoloni A, Dini F, Farese A, Rosso A, Tinacci L, Paradisi F. Tropical pulmonary eosinophilia. Report of a case. Ann Med Interne (Paris) 1998; 148:321-2. [PMID: 9515101] [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: 02/06/2023]
Abstract
Tropical pulmonary eosinophilia (TPE) is an unusual manifestation of filarial infection, most commonly found in South-East Asia and caused by immunologic hyperresponsiveness to Wuchereria bancrofti and Brugia malayi. This report concerns a case of TPE in a 25-year-old Indian male who had been living in Italy for two years and was admitted to hospital with chest pain. Diethylcarbamazine therapy proved effective in rapidly eliminating symptoms and pulmonary abnormalities, as well as normalizing of laboratory findings.
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Affiliation(s)
- A Bartoloni
- Clinica di Malattie Infettive, Università di Firenze, Italia
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22
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Tulli G, Cellerini A, Farese A, Mangani V, Oggioni R, Zolfanelli F. ICU acquired late pneumonia: epidemiological, clinical, bacteriological and histological aspects of a 3 years study. Crit Care 1998. [PMCID: PMC3301344 DOI: 10.1186/cc232] [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: 11/18/2022] Open
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23
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Dionisio D, Tortoli E, Simonetti MT, di Lollo S, Meli M, Farese A, Fontana R, Sterrantino G, Leoncini F. [Intestinal mycobacterial infections in AIDS. Clinical course and treatment of infections caused by Mycobacterium avium, Mycobacterium kansasii, Mycobacterium genavense]. Recenti Prog Med 1994; 85:526-36. [PMID: 7855386] [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: 01/27/2023]
Abstract
Digestive apparatus is a common target of atypical mycobacteriosis in AIDS patients (at least 50% of patients with CD4+ lymphocytes < 50/mm3). We describe the clinical-histological features of two cases of Whipple-like syndrome likely caused by Mycobacterium avium (MAI) (study performed by light and electron microscopy), of one case of infection caused by two morphological variants of a MAI strain with a different sensitivity to antibiotics, of one case of M. kansasii infection and of two cases of M. genavense infection accompanied by sensitivity tests to antibiotics (as far as we know, these are the first described quantitative sensitivity tests of M. genavense to antibiotics). In conclusion, we discuss the present therapeutical outlines for M. kansasii and avium, together with the teramporary pharmacological options for M. genavense as suggested by antibiotic sensitivity tests performed on the strains isolated from the studied patients.
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Affiliation(s)
- D Dionisio
- U.O. Malattie Infettive, Ospedale di Careggi, Firenze
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Eichacker PQ, Waisman Y, Natanson C, Farese A, Hoffman WD, Banks SM, MacVittie TJ. Cardiopulmonary effects of granulocyte colony-stimulating factor in a canine model of bacterial sepsis. J Appl Physiol (1985) 1994; 77:2366-73. [PMID: 7532649 DOI: 10.1152/jappl.1994.77.5.2366] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [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: 01/25/2023] Open
Abstract
We investigated the effects of recombinant granulocyte colony-stimulating factor (G-CSF) in a canine model of septic shock. Awake 2-yr-old beagles were studied before and after intraperitoneal placement of an Escherichia coli-infected clot. Nine days before and until 3 days after clot placement, animals received daily high-dose (G-CSF (5 microgram/kg body wt; n = 17), low-dose G-CSF (0.1 microgram/kg body wt; n = 17), or a control protein (5 micrograms/kg body wt; n = 20). Survival rate was greater (P < 0.04, Wilcoxon test) in the high-dose G-CSF group (14/17) than in the low-dose G-CSF (10/17) and control (12/20) groups. High-dose G-CSF improved cardiovascular function, as evidenced by increased left ventricular ejection fraction (day 1 after clot; P < 0.001) and mean arterial pressure (day 2; P < 0.02) compared with low-dose G-CSF and control groups. High-dose G-CSF increased (P < 0.001) mean peripheral neutrophils before (-3 days) and after (2 h to 4 days) clot and produced a more rapid (P < 0.001) rise (day 2) and fall (day 4) in mean alveolar neutrophil numbers compared with the low-dose G-CSF and control groups. High-dose G-CSF decreased mean serum endotoxin (2-8 h; P < 0.002) and tumor necrosis factor (2 h; P < 0.02) levels and lowered blood bacteria counts (2-6 h; P < 0.04) compared with the low-dose G-CSF and control groups. Thus, in this canine model, G-CSF sufficient to increase peripheral neutrophils before and during peritonitis and septic shock enhances host defense, reduces cytokine (tumor necrosis factor) levels, and improves cardiovascular function and survival.
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Affiliation(s)
- P Q Eichacker
- Armed Forces Radiobiology Research Institute, Defense Nuclear Agency, Bethesda 20814
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Farese A, Pozzi M, Patussi V, Ballerini G, Arena U, Surrenti C. Piezoelectric extracorporeal shock wave lithotripsy in 93 patients with gallstones. Ital J Gastroenterol 1993; 25:251-5. [PMID: 8353298] [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: 01/30/2023]
Abstract
Ninety-three patients with gallstones were selected for extracorporeal shock wave lithotripsy (ESWL) with a piezoelectric device (EDAP LT-OI) to verify the efficacy and safety of this technique. Neuroleptoanalgesia with intravenous diazepam and phentanyl was performed in almost all patients. The treatment was combined with adjuvant litholytic therapy using oral ursodeoxycholic acid. Follow-up period was nine months. Piezoelectric ESWL was able to disintegrate radiolucent gallstones in 97.9% of cases. By the ninth month 68 patients (73.1%) were stone-free. Best results were obtained with single stones smaller than 20 mm. After ESWL, surgical cholecystectomy was necessary in 2.1% of cases. This study confirms the efficacy and safety of piezoelectric extracorporeal shock wave lithotripsy combined with ursodeoxycholic acid adjuvant therapy for selected cases of gallstone disease.
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Affiliation(s)
- A Farese
- Dipartimento di Fisiopatologia Clinica, Università di Firenze, Italy
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Eichacker PQ, Hoffman WD, Farese A, Danner RL, Suffredini AF, Waisman Y, Banks SM, Mouginis T, Wilson L, Rothlein R. Leukocyte CD18 monoclonal antibody worsens endotoxemia and cardiovascular injury in canines with septic shock. J Appl Physiol (1985) 1993; 74:1885-92. [PMID: 8099906 DOI: 10.1152/jappl.1993.74.4.1885] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [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: 01/28/2023] Open
Abstract
We investigated the effects of a murine monoclonal antibody directed against the canine leukocyte CD11/18 adhesion complex (MAb R15.7) in a canine model of septic shock. Awake 2-yr-old purpose-bred beagles were studied 7 days before and 1, 2, 4, and 10 days after intraperitoneal placement of an Escherichia coli-infected fibrin clot. Starting 12 h before clot placement, animals received 0.5-1 mg/kg iv every 12 h (4 doses total) of either MAb R15.7 (MAb group, n = 8) or, as controls, murine serum protein (n = 8). After infected clot placement, all animals received antibiotic (ceftriaxne, 100 mg.kg-1.day-1 for 4 days). Two of eight control animals and four of eight MAb animals died (P = 0.4). During the first 8 h after clot placement, MAb animals, compared with control animals, had greater (P < 0.06) increases in serum endotoxin levels and higher (P < 0.05) neutrophil counts. Day 1 after clot placement, MAb animals, compared with control animals, had decreased (P < 0.05) central venous pressure and arterial pH and increased (P < 0.05) arterial lactate. Day 2 after clot placement, MAb animals, compared with control animals, had decreased (P < 0.05) cardiac index and mean arterial pressure. In summary, MAb R15.7, although associated with increased neutrophil counts, worsened serum endotoxemia, acidosis, and cardiovascular function in this canine model of septic shock. These data suggest that in septic shock, antibody directed against this leukocyte membrane protein complex may be harmful, possibly via impairment of normal leukocyte function.
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Affiliation(s)
- P Q Eichacker
- Critical Care Medicine Department, National Institutes of Health, Bethesda 20892
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Eichacker PQ, Farese A, Hoffman WD, Banks SM, Mouginis T, Richmond S, Kuo GC, Macvittie TJ, Natanson C. Leukocyte CD11b/18 antigen-directed monoclonal antibody improves early survival and decreases hypoxemia in dogs challenged with tumor necrosis factor. Am Rev Respir Dis 1992; 145:1023-9. [PMID: 1586042 DOI: 10.1164/ajrccm/145.5.1023] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This study examined the effect of monoclonal antibody (MAb) directed against leukocyte CD11b/18 glycoprotein complex (904MAb) on cardiopulmonary injury induced by tumor necrosis factor (TNF), and death. Eighteen 2-yr-old, purpose-bred beagles with chronic tracheostomies were challenged with TNF (60 micrograms/kg of body weight) intravenously. Nine of 18 animals were treated with 0.5 to 1.0 mg/kg of body weight 904MAb intravenously 45 min before and 12, 36, and 48 h after TNF infusion. Serial femoral and pulmonary arterial catheter hemodynamics, blood gas analysis, and radionuclide cineangiographic left ventricular ejection fractions (EF) were done before and after a fluid challenge. Serial bronchoalveolar lavages (BAL) with cell and protein analysis also were performed using the chronic tracheostomies. Compared with animals given TNF alone, animals treated with 904MAb did not differ in overall survival (TNF alone, 2/9; 904MAb, 3/9); however, the group of animals treated with 904MAb had significantly (p less than 0.01) fewer deaths within the first 30 h of TNF challenge. At 4 h after TNF challenge, all animals had significantly (p less than 0.05) reduced PaO2 after fluid challenge; however, animals given 904MAb (compared with animals given TNF alone) had significantly (p less than 0.05) smaller reductions in PaO2. Throughout the study, animals given 904MAb before TNF or TNF alone had similar changes in cardiac index, mean arterial pressure, EF, and BAL protein and neutrophil concentration. Thus, MAb directed against the leukocyte CD11b/18 glycoprotein complex prolonged survival and reduced the hypoxemia occurring after TNF challenge, but this antibody did not improve overall survival or cardiopulmonary function.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Q Eichacker
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland 20892
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Eichacker PQ, Hoffman WD, Farese A, Banks SM, Kuo GC, MacVittie TJ, Natanson C. TNF but not IL-1 in dogs causes lethal lung injury and multiple organ dysfunction similar to human sepsis. J Appl Physiol (1985) 1991; 71:1979-89. [PMID: 1761500 DOI: 10.1152/jappl.1991.71.5.1979] [Citation(s) in RCA: 53] [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: 12/28/2022] Open
Abstract
We compared the early and late pulmonary effects of human recombinant tumor necrosis factor (TNF) and interleukin 1 (IL-1) challenges in awake dogs with chronic tracheostomies. Serial blood gas analysis, bronchoalveolar lavage (BAL) with cell and protein analysis, intravascular catheter hemodynamics, and radionuclide left ventricular ejection fractions (LVEF) were determined before and after infusion of TNF (60 micrograms/kg body wt, n = 8), IL-1 (1,000 micrograms/kg body wt, n = 6), or heat-inactivated IL-1 (n = 6, controls). Controls given heat-inactivated IL-1 had no changes (P = NS) in any pulmonary parameter throughout the study. Animals given IL-1 had a transient increase (P less than 0.05) in BAL neutrophil concentration 1 day after infusion but no other changes (P = NS) in pulmonary function throughout the study. Animals given TNF had early (0-4 h) decreases (P less than 0.05) in arterial PO2, increases (P less than 0.05) in physiological shunt fraction and alveolar-to-arterial PO2 gradient, and a high mortality rate (50%). In TNF animals, volume challenges at 4 h were associated (P less than 0.05) with death and noncardiogenic pulmonary edema. In TNF survivors, hypoxemia persisted for 2-3 days and was associated with increases (P less than 0.05) in alveolar protein and neutrophil concentration on days 1 and 3, respectively, which in survivors returned to near normal over 6-21 days. Animals challenged with TNF and not IL-1 had reversible depression of LVEF similar in time course to abnormalities in arterial PO2. In this study, TNF (but not IL-1) challenges were lethal and produced acute pulmonary dysfunction sustained over days (reversible in survivors) that was similar to that seen in human septic shock. The ability of TNF to induce pulmonary injury similar to bacterial shock suggests that TNF is a key mediator of sepsis-induced lung injury. Furthermore, because TNF challenge induced both sustained pulmonary and cardiac injury, TNF may be a common pathway for the multiple organ dysfunction that occurs during septic shock.
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Affiliation(s)
- P Q Eichacker
- Critical Care Medicine Department, National Institutes of Health, Bethesda 20892
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Abstract
Sclerotherapy of esophageal varices is an effective hemostatic treatment and may also prevent bleeding. In our study, we examined the effects of prophylactic sclerotherapy on esophageal motility in 15 patients with Child's A cirrhosis of the liver. All the patients underwent three manometric measurements, performed respectively before the sclerotherapy, 1 week after the eradication of varices, and 3 months later. The results of our study show that prophylactic sclerotherapy of esophageal varices does not significantly change the resting pressure and length of the lower esophageal sphincter. Neither the amplitude nor the duration of the postswallowing esophageal peristaltic waves is significantly influenced by sclerotherapy. However, sclerotherapy produces a significant increase in tertiary contractions in the distal esophagus, which could explain the onset of dysphagia among patients in whom postsclerotherapy stricture is not evident.
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Affiliation(s)
- E Bovero
- Department of Gastroenterology, Ospedale S. Martino, Genova, Italy
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Torre F, Bovero E, Farese A, Oddone D, Vinci P, Bafico GL, Pagliari R, Borgo E. [Effectiveness of sublingual isosorbide dinitrate in chest pain: coronary or esophageal angina?]. Minerva Cardioangiol 1987; 35:75-7. [PMID: 3561812] [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: 01/06/2023]
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