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Caraffa E, Mascia C, Ciardi MR, Lichtner M, Ajassa C, Del Borgo C, Tieghi T, Vita S, Savinelli S, Iannetta M, Russo G, Mastroianni CM, Vullo V. Steroid use in measles: A retrospective cohort study during the 2017 outbreak in tertiary referral center, Rome and Latina, Italy. J Infect Chemother 2024; 30:201-207. [PMID: 37820949 DOI: 10.1016/j.jiac.2023.10.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Since early January 2017, a new measles outbreak in Italy has been observed. The aim of the study was to compare features between adults and children measles cases and evaluate the effect of steroid treatment on the above parameters. METHODS A retrospective multicenter, descriptive study was performed. We analyzed all patients admitted to the Department of Public Health and Infectious Diseases, Sapienza University, Rome and Latina, from January 2017 to December 2017 and discharged with diagnosis of measles. RESULTS We identified 113 patients discharged with the diagnosis of measles infection cases of which 59 adults and 54 children (≤16 years). In adult population 32 patients (54 %) were males, with a median age of 30.5 years old and all unvaccinated (100 %). Keratoconjunctivitis 30 (50 %) was the most frequent complication. In pediatric population 27 (50 %) patients were males, with a median age of 3 years old. Information on measles vaccination status was available for only 21 (38.8 %) of cases. Keratoconjunctivitis 40 (74 %) was the most frequent complication. Analyzing the differences between adult and pediatric patients we found that children were significantly more likely to have keratoconjunctivitis and diarrhea as complications than adults in which the rate of thrombocytopenia and hepatitis was highest. Thirty-nine adult subjects (66 %) have been treated with systemic corticosteroids. CONCLUSIONS Pediatric patients differ from adults in complications and liver involvement. Regarding steroids use, although there is no clear indication of steroid use during measles, there is no evidence of a worse outcome in our cases series.
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Affiliation(s)
- Emanuela Caraffa
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy.
| | - Claudia Mascia
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Maria Rosaria Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy
| | - Tiziana Tieghi
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy
| | - Serena Vita
- Infectious Diseases Unit, Sapienza University, Santa Maria Goretti Hospital, Latina, Italy; National Institute for Infectious Diseases Lazzaro Spallanzani, IRCCS, Rome, Italy
| | - Stefano Savinelli
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Department of Infectious Diseases, St Vincent's University Hospital, Dublin, Ireland
| | - Marco Iannetta
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy; Department of Systems Medicine and Infectious Diseases Clinic, University Hospital Tor Vergata, Rome, Italy
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
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Antonelli G, Focosi D, Turriziani O, Tuccori M, Brandi R, Fillo S, Ajassa C, Lista F, Mastroianni CM. Corrigendum to "Virological and clinical rebounds of COVID-19 soon after nirmatrelvir/ritonavir discontinuation" [Clin Microbiol Infect 28 (12) (2022 Dec) 1657-1658]. Clin Microbiol Infect 2024; 30:408. [PMID: 38103639 PMCID: PMC11021203 DOI: 10.1016/j.cmi.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy.
| | - Ombretta Turriziani
- Department of Molecular Medicine, Sapienza University of Rome, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, Unit of Adverse Drug Reactions Monitoring, Pisa University Hospital, Pisa, Italy
| | | | - Silvia Fillo
- Scientific Department, Army Medical Center, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | | | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
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Maddaloni L, Santinelli L, Bugani G, Cacciola EG, Lazzaro A, Lofaro CM, Caiazzo S, Frasca F, Fracella M, Ajassa C, Leanza C, Napoli A, Cinti L, Gaeta A, Antonelli G, Ceccarelli G, Mastroianni CM, Scagnolari C, d'Ettorre G. Differential expression of Type I interferon and inflammatory genes in SARS-CoV-2-infected patients treated with monoclonal antibodies. Immun Inflamm Dis 2023; 11:e968. [PMID: 37904704 PMCID: PMC10571496 DOI: 10.1002/iid3.968] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/07/2023] [Accepted: 07/20/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION Considering the reported efficacy of monoclonal antibodies (mAbs) directed against the Spike (S) protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in reducing disease severity, the aim of this study was to investigate the innate immune response before and after mAbs treatment in 72 vaccinated and 31 unvaccinated SARS-CoV-2 patients. METHODS The mRNA levels of IFN-I, IFN-related genes and cytokines were evaluated using RT/real-time quantitative PCR. RESULTS Vaccinated patients showed increased rate of negative SARS-CoV-2 PCR tests on nasopharyngeal swab compared with unvaccinated ones after mAbs treatment (p = .002). Unvaccinated patients had lower IFN-α/ω and higher IFN-related genes (IFNAR1, IFNAR2, IRF9, ISG15, ISG56 and IFI27) and cytokines (IL-6, IL-10 and TGF-β) mRNA levels compared to vaccinated individuals before mAbs (p < .05 for all genes). Increased IFN-α/ω, IFNAR1, IFNAR2 and IRF9 levels were observed in unvaccinated patients after mAbs treatment, while the mRNA expression ISGs and IL-10 were reduced in all patients. CONCLUSION These data suggest that anti-S vaccinated patients have increased levels of innate immune genes compared to unvaccinated ones. Also, gene expression changes in IFN genes after mAbs administration are different according to the vaccination status of patients.
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Affiliation(s)
- Luca Maddaloni
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Letizia Santinelli
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Ginevra Bugani
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Elio G. Cacciola
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Alessandro Lazzaro
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Chiara M. Lofaro
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Sara Caiazzo
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Federica Frasca
- Virology Laboratory, Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Matteo Fracella
- Virology Laboratory, Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Camilla Ajassa
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Cristiana Leanza
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Anna Napoli
- Laboratory of Microbiology and Virology, Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Lilia Cinti
- Laboratory of Microbiology and Virology, Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Aurelia Gaeta
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
| | - Guido Antonelli
- Virology Laboratory, Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Giancarlo Ceccarelli
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
- Azienda Ospedaliero‐Universitaria Policlinico Umberto IRomeItaly
| | | | - Carolina Scagnolari
- Virology Laboratory, Department of Molecular MedicineSapienza University of RomeRomeItaly
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious DiseasesSapienza University of RomeRomeItaly
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Leone F, Cotugno N, Casamento Tumeo C, Zangari P, Palomba P, Adorisio R, De Benedetti F, Bracaglia C, Papoff P, Ajassa C, Palma P, Bernardi S. Hyperinflammatory syndrome in a paediatric patient with a recent diagnosis of HIV/AIDS infection: hemophagocytic lymphohistiocytosis or immune reconstitution syndrome? BMC Infect Dis 2023; 23:477. [PMID: 37464267 DOI: 10.1186/s12879-023-08457-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Haemophagocytic lymphohistiocytosis is a rare and life-threatening condition caused by uncontrolled immune activation leading to excessive inflammation and tissue destruction. It could either be due to a primary genetic defect or be triggered by secondary causes such as infections, autoimmune diseases, rheumatological diseases or post-transplant immunosuppression. We here report the case of a 4-year-old child with a recent AIDS diagnosis who developed a severe systemic inflammation. CASE REPORT We here report the case of a 4-year-old child with a recent AIDS diagnosis who was admitted to the ER with acute respiratory failure due to Pneumocystis jiroveci infection and Aspergillosis; the following microbiological assessment also showed a CMV, HSV, EBV and HHV-7 coinfection. On the 51st day after she'd started antiretroviral therapy, 39th after she'd followed a course of Bactrim and Caspofungin for PJI and Ambisome for pulmonary Aspergillosis, she started presenting fever, unresponsive to broad-spectrum antibiotic therapy. She also presented worsening of her clinical conditions, with evidence at the laboratory assessments of progressive raise in inflammatory indexes, coagulopathy, trilinear cytopenia and hyperferritinemia. To perform the differential diagnosis between IRIS and HLH, HLA-DR on T cells was studied, turning out negative for IRIS. Therefore, in the suspicion of HLH, a bone marrow aspirate and biopsy were performed with evidence of trilinear cytopenia, prevalence of T-cells and macrophages with signs of phagocytosis. She was started on high-dose steroids and Anakinra for a total of 29 days, resulting in prompt apyrexia and progressive improvement of her clinical conditions and laboratory results. CONCLUSION To the best of our knowledge there is poor literature available about the differential diagnosis of HLH and IRIS, therefore medical management in the concurrence of these two conditions needs to be further investigated, especially in a setting where immunological testing is not quickly available. The clinical differences between these pathologies are blurred and the bone marrow biopsy within marker for IRIS helped us to distinguish these two entities.
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Affiliation(s)
- Fabrizio Leone
- Policlinico Umberto I, Maternal Infantile and Urological Sciences Department, Sapienza University of Rome, Rome, Italy.
| | - Nicola Cotugno
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children Hospital, IRCCS, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Chiara Casamento Tumeo
- Academic Department of Pediatrics (DPUO), Bambino Gesù Pediatric Hospital, IRCCS, Rome, Italy
| | - Paola Zangari
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Patrizia Palomba
- Microbiology and Diagnostic Immunology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rachele Adorisio
- Heart Failure, Transplant and Mechanical Cardiocirculatory Support Unit, Department of Pediatric Cardiology and Cardiac Surgery, Heart Lung Transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, Rome, Italy
| | | | - Claudia Bracaglia
- Division of Rheumatology, Bambino Gesù Children's Hospital, IRCCS, Roma, Italy
| | - Paola Papoff
- Department of Pediatrics, Pediatric Intensive Care Unit, Umberto I Policlinico, Sapienza University of Rome, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paolo Palma
- Clinical and Research Unit of Clinical Immunology and Vaccinology, Academic Department of Pediatrics (DPUO), Bambino Gesù Children Hospital, IRCCS, Rome, Italy
- Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Stefania Bernardi
- Unit of Immune and Infectious Disease, University Department of Pediatrics, DPUO, Bambino Gesù Children's Hospital, Rome, Italy
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Antonelli G, Focosi D, Turriziani O, Tuccori M, Brandi R, Fillo S, Ajassa C, Lista F, Mastroianni CM. Virological and clinical rebounds of COVID-19 soon after nirmatrelvir/ritonavir discontinuation. Clin Microbiol Infect 2022; 28:1657-1658. [PMID: 35792281 PMCID: PMC9250152 DOI: 10.1016/j.cmi.2022.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/09/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Daniele Focosi
- North-Western Tuscany Blood Bank, Pisa University Hospital, Pisa, Italy.
| | - Ombretta Turriziani
- Department of Molecular Medicine, Sapienza University of Rome, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Unit of Adverse Drug Reactions Monitoring, Pisa University Hospital, Pisa, Italy
| | | | - Silvia Fillo
- Scientific Department, Army Medical Center, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
| | | | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University Hospital "Policlinico Umberto I", Rome, Italy
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La Torre G, Marte M, Massetti AP, Carli SM, Romano F, Mastroianni CM, Minorenti M, Alessandri F, Ajassa C, Fusconi M, De Vincentiis M, de Meo D, Villani C, Cardi M, Pugliese F. The neutrophil/lymphocyte ratio as a prognostic factor in COVID-19 patients: a case-control study. Eur Rev Med Pharmacol Sci 2022; 26:1056-1064. [PMID: 35179773 DOI: 10.26355/eurrev_202202_28017] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) has been identified in China as responsible for viral pneumonia, now called COVID-19 (Coronavirus Disease 2019). Patients infected can develop common symptoms like cough and sore throat, and, in severe cases, acute respiratory syndrome and even death. To optimize the available resources, it is necessary to identify in advance the subjects that will develop a more serious illness, therefore requiring intensive care.The neutrophil / lymphocyte ratio (NLR) parameter, resulting from the blood count, could be a significant marker for the diagnosis and management of risk stratification. PATIENTS AND METHODS A retrospective, single-center case-control observational study was conducted. The differential cell count of leukocytes, the NLR and the clinical course of patients hospitalized in intensive care with COVID-19 were analyzed, comparing them with other patients (COVID-19 and non-COVID-19) and healthy individuals selected among workers of the Teaching Hospital Policlinico Umberto I in Rome. RESULTS 370 patients (145 cases and 225 controls) were included in the case-control study, 211 males (57%) and 159 females (43%). The average age of the population was 63 years (SD 16.35). In the group of cases, out of 145 patients, 57 deaths and 88 survivors were recorded, with a lethality rate of 39.3%. The group of cases has an NLR of 7.83 (SD = 8.07), a much higher value than the control group where an NLR of 2.58 was recorded (SD = 1.93) (p <0.001). The Neutrophils / Lymphocytes ratio may prove to be a diagnostic factor for COVID-19, an NLR> 3.68 revealed an OR 10.84 (95% CI = 6.47 - 18.13) (p <0.005). CONCLUSIONS The value of NLR considered together with the age variable allows a risk stratification and allows the development of diagnostic and treatment protocols for patients affected by COVID-19. A high neutrophil to lymphocyte ratio suggests worse survival. Risk stratification and management help alleviate the shortage of medical resources and reduce the mortality of critically ill patients.
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Affiliation(s)
- G La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
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7
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Rando E, Oliva A, Cancelli F, D'Agostino C, Savelloni G, Ciardi MR, Ajassa C, Siccardi G, Galardo G, Mastroianni CM. Clinical characteristics and risk factors for mortality in COVID-19 patients during the first wave of the COVID-19 pandemic in Rome, Italy: a single-center retrospective study. Infez Med 2022; 31:49-54. [PMID: 36908386 PMCID: PMC9994829 DOI: 10.53854/liim-3101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/27/2023] [Indexed: 03/07/2023]
Abstract
Background Since the beginning of 2020, the SARS-CoV-2 pandemic has become a serious public health problem. Numerous studies have highlighted the main clinical features of COVID-19, mainly the huge heterogeneity of the clinical manifestations that can vary from asymptomatic infection to serious viral pneumonia with a high mortality rate. The aim of this study was to analyze retrospectively the clinical characteristics and assess the risk factors for mortality in an Italian cohort of patients with COVID-19. Methods Retrospective analysis including patients with COVID-19 admitted to the Infectious Diseases wards of Azienda Ospedaliera Universitaria Policlinico "Umberto 1", Rome, from March 2020 to May 2020. The data were part of an electronic anonymous web-based database processed by SIMIT (Italian Society of Infectious and Tropical Diseases). Results 258 patients were included in the analysis, and 34 (13.2%) died. The median age was 62 (IQR, 52-74), 106 (40%) were women, and 152 (60%) were males, 172 (66.7%) had at least one co-morbidity. The most common signs and symptoms were: fever [221 (85.6%)], cough [135 (52.3%)], and dyspnea [133 (51.5%)]. The PaO2/FiO2 ratio was often altered [352 (IQR, 308-424)]. Lymphopenia [lymphocyte counts, 875/μL (IQR, 640-1250)] and high levels of D-dimer [mg/dL, 874 (IQR, 484-1518)] were found. Non-survivors were older than survivors [median age, 74 (IQR, 67-85)] vs. 61 (QR, 51-72)], mostly men [25 (73.5%)] and more frequently with more than 2 comorbidities [21 (61.8%) vs. 94 (42.1%)]. In the multiple logistic regression model, the variables associated with in-hospital mortality were age [OR, 3.65 (95% CI, 1.22-10.89)], male gender [OR, 2.99 (95% CI, 1.18-7.54)], blood urea [OR, 2.76 (95% CI, 1.20-6.35)] and a low PaO2/FiO2 ratio [OR, 0.28 (95% CI, 0.12-0.62)]. Conclusion The mortality rate in COVID-19 was 13,2%. The risk factors associated with in-hospital mortality were advanced age, male sex, increased blood urea, and the PaO2/FiO2 ratio reduction.
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Affiliation(s)
- Emanuele Rando
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Francesca Cancelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudia D'Agostino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Giulia Savelloni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guido Siccardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Gioacchino Galardo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
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8
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Conti MG, Natale F, Stolfi I, Pedicino R, Boscarino G, Ajassa C, Cardilli V, Ciambra GL, Guadalupi L, Favata P, Repole P, De Luca F, Zacco G, Brunelli R, Terrin G. Consequences of Early Separation of Maternal-Newborn Dyad in Neonates Born to SARS-CoV-2 Positive Mothers: An Observational Study. Int J Environ Res Public Health 2021; 18:5899. [PMID: 34072815 PMCID: PMC8199070 DOI: 10.3390/ijerph18115899] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 12/18/2022]
Abstract
As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues its spread all over the world, data on perinatal management of the maternal-infant dyad are urgent. We performed an observational study to describe the effects of the early separation of the maternal-infant dyad, in case of maternal SARS-CoV-2 infection. We reported the medical records for 37 neonates born to 37 SARS-CoV-2 positive mothers in a setting of separation of the dyad after birth. Data on neonatal infection, clinical condition, and breastfeeding rate were recorded until the first month of life. No maternal deaths were recorded; 37.8% of women had at least one pregnancy-related complication. We reported a high adherence to recommended safety measures after discharged with 84.8% of the mothers using at least one personal protective device and 51.5% using all the protective devices. We reported one case of vertical transmission and no cases of horizontal transmission. However, the separation of the dyad had a negative impact on breastfeeding because only 23.5% of the newborns received exclusively human milk during the first month of life. Despite early separation of the dyad protecting the newborns from possible horizontal transmission of SARS-CoV-2, it negatively affects breastfeeding during the first months of life.
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Affiliation(s)
- Maria Giulia Conti
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Roma, Italy
| | - Fabio Natale
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Ilaria Stolfi
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Roberto Pedicino
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Giovanni Boscarino
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Camilla Ajassa
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Viviana Cardilli
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Giovanni Luca Ciambra
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Laura Guadalupi
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Paola Favata
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Paola Repole
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Francesca De Luca
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Giulia Zacco
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Roberto Brunelli
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
| | - Gianluca Terrin
- Department of Maternal and Child Health, Policlinico Umberto I Hospital, Sapienza University of Rome, 00161 Roma, Italy; (M.G.C.); (F.N.); (I.S.); (R.P.); (G.B.); (C.A.); (V.C.); (G.L.C.); (L.G.); (P.F.); (P.R.); (F.D.L.); (G.Z.); (R.B.)
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9
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Zingaropoli MA, Nijhawan P, Carraro A, Pasculli P, Zuccalà P, Perri V, Marocco R, Kertusha B, Siccardi G, Del Borgo C, Curtolo A, Ajassa C, Iannetta M, Ciardi MR, Mastroianni CM, Lichtner M. Increased sCD163 and sCD14 Plasmatic Levels and Depletion of Peripheral Blood Pro-Inflammatory Monocytes, Myeloid and Plasmacytoid Dendritic Cells in Patients With Severe COVID-19 Pneumonia. Front Immunol 2021; 12:627548. [PMID: 33777012 PMCID: PMC7993197 DOI: 10.3389/fimmu.2021.627548] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Background Emerging evidence argues that monocytes, circulating innate immune cells, are principal players in COVID-19 pneumonia. The study aimed to investigate the role of soluble (s)CD163 and sCD14 plasmatic levels in predicting disease severity and characterize peripheral blood monocytes and dendritic cells (DCs), in patients with COVID-19 pneumonia (COVID-19 subjects). Methods On admission, in COVID-19 subjects sCD163 and sCD14 plasmatic levels, and peripheral blood monocyte and DC subsets were compared to healthy donors (HDs). According to clinical outcome, COVID-19 subjects were divided into ARDS and non-ARDS groups. Results Compared to HDs, COVID-19 subjects showed higher sCD163 (p<0.0001) and sCD14 (p<0.0001) plasmatic levels. We observed higher sCD163 plasmatic levels in the ARDS group compared to the non-ARDS one (p=0.002). The cut-off for sCD163 plasmatic level greater than 2032 ng/ml was predictive of disease severity (AUC: 0.6786, p=0.0022; sensitivity 56.7% [CI: 44.1–68.4] specificity 73.8% [CI: 58.9–84.7]). Positive correlation between plasmatic levels of sCD163, LDH and IL-6 and between plasmatic levels of sCD14, D-dimer and ferritin were found. Compared to HDs, COVID-19 subjects showed lower percentages of non-classical (p=0.0012) and intermediate monocytes (p=0.0447), slanDCs (p<0.0001), myeloid DCs (mDCs, p<0.0001), and plasmacytoid DCs (pDCs, p=0.0014). Compared to the non-ARDS group, the ARDS group showed lower percentages of non-classical monocytes (p=0.0006), mDCs (p=0.0346), and pDCs (p=0.0492). Conclusions The increase in sCD163 and sCD14 plasmatic levels, observed on hospital admission in COVID-19 subjects, especially in those who developed ARDS, and the correlations of these monocyte/macrophage activation markers with typical inflammatory markers of COVID-19 pneumonia, underline their potential use to assess the risk of progression of the disease. In an early stage of the disease, the assessment of sCD163 plasmatic levels could have clinical utility in predicting the severity of COVID-19 pneumonia.
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Affiliation(s)
| | - Parni Nijhawan
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Anna Carraro
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pasculli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Paola Zuccalà
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Valentina Perri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Raffaella Marocco
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Blerta Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Guido Siccardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Cosmo Del Borgo
- Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Ambrogio Curtolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Marco Iannetta
- Department of System Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.,Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
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10
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Stolfi I, Conti MG, Marciano A, Dito L, Natale F, Bartolucci M, Cellitti R, Regoli D, Ticchiarelli A, Pangallo I, Pagano F, Ajassa C, Brunelli R, Terrin G. Liver Involvement in SARS-CoV-2 Vertically Infected Newborn: A Case Report. Front Pediatr 2021; 9:701722. [PMID: 34858898 PMCID: PMC8632015 DOI: 10.3389/fped.2021.701722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatal SARS-CoV-2 infection can occur antenatally, peripartum, or postnatally. In the newborn, clinical manifestations may vary including fever and respiratory, gastrointestinal and neurological symptoms. Most commonly, they are subclinical. We herein present a case of vertical transmission of SARS-CoV-2 presenting with liver injury, characterized by an increase in serum transaminases.
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Affiliation(s)
- Ilaria Stolfi
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy.,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Marciano
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Lucia Dito
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Fabio Natale
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Monica Bartolucci
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Raffaella Cellitti
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Daniela Regoli
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | | | - Ida Pangallo
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Federica Pagano
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Roberto Brunelli
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
| | - Gianluca Terrin
- Department of Maternal and Child Health, Sapienza University of Rome, Rome, Italy
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11
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Vena A, Giacobbe DR, Mussini C, Cattelan A, Bassetti M, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E. Clinical Efficacy of Ceftolozane-Tazobactam Versus Other Active Agents for the Treatment of Bacteremia and Nosocomial Pneumonia due to Drug-Resistant Pseudomonas aeruginosa. Clin Infect Dis 2020; 71:1799-1801. [DOI: 10.1093/cid/ciaa003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio Vena
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Cristina Mussini
- Infectious Diseases Clinics, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Cattelan
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
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12
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Capotosto L, D'Ettorre G, Ajassa C, Cavallari N, Ciardi MR, Placanica G, Ricci S, Lucchetti P, Tanzilli G, Mangieri E, Gaudio C, Vullo V, Vitarelli A. Assessment of Biventricular Function by Three-Dimensional Speckle Tracking Echocardiography in Adolescents and Young Adults with Human Immunodeficiency Virus Infection: A Pilot Study. Cardiology 2019; 144:101-111. [PMID: 31614346 DOI: 10.1159/000503140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/16/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The purpose of the study was to assess biventricular parameters of wall deformation with three-dimensional speckle tracking echocardiography (3DSTE) in adolescents and young adults with human immunodeficiency virus (HIV) infection on antiretroviral therapy in order to detect a possible subclinical myocardial dysfunction. METHODS Twenty-one patients aged 12-39 years with HIV, 21 normal controls of the same age and sex, and 21 patients with idiopathic nonischemic dilated cardiomyopathy (DCM) were studied with 3DSTE. All HIV patients were stable in terms of HIV infection, with no history of heart disease or other chronic systemic disease except HIV infection, and were on highly active antiretroviral therapy with good immunological control. Standard echocardiographic measures of left ventricular (LV)-right ventricular (RV) function were assessed. 3D LV global longitudinal strain (GLS), circumferential strain, radial strain, and LV twist were calculated. Global area strain (GAS) was calculated by 3DSTE as percentage variation in surface area defined by the longitudinal and circumferential strain vectors. 3D RV global and free-wall longitudinal strain (FWLS) were obtained. RESULTS LV GLS and GAS were lower in HIV patients compared to normal controls (p = 0.002, and p = 0.01, respectively). There were no significant differences in LV ejection fractions between the groups. There was a weak positive correlation between LV GLS and age (r = 0.215, p = 0.034) and a weak negative correlation between LV GLS and nadir-CD4 T-cells count (r = 0.198, p = 0.043). DCM patients had more marked and widespread reduction in LV GLS and GAS compared to controls (p < 0.001), whereas in HIV patients LV strain impairment (p < 0.05) was more localized in basal and apical regions. RV FWLS was significantly reduced in HIV patients when compared with the control group (p = 0.03). No patient had pulmonary systolic pressure higher than 35 mm Hg. CONCLUSIONS 3DSTE may help to identify HIV patients at high cardiovascular risk allowing early detection of biventricular dysfunction in the presence of normal LV ejection fraction and in the absence of pulmonary hypertension. LV strain impairment in HIV patients is less prominent and widespread compared to DCM patients.
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Affiliation(s)
| | | | - Camilla Ajassa
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Nelson Cavallari
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Serafino Ricci
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | - Pietro Lucchetti
- Department of Infectious Diseases, Sapienza University, Rome, Italy
| | | | | | - Carlo Gaudio
- Department of Cardiology, Sapienza University, Rome, Italy
| | - Vincenzo Vullo
- Department of Infectious Diseases, Sapienza University, Rome, Italy
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13
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Vassalini P, Ajassa C, Di Ruscio V, Morace A, Vergari J, Tosato C, Savelloni G, Mastroianni CM. Aseptic meningitis induced by intravenous immunoglobulins in a child with acute Epstein-Barr virus infection and thrombocytopenia. Infez Med 2019; 27:194-197. [PMID: 31205046] [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: 06/09/2023]
Abstract
Drug-induced aseptic meningitis (DIAM) represents a diagnostic challenge since clinical and cerebrospinal fluid (CSF) findings may be indistinguishable from a bacterial meningitis. Intravenous immunoglobulin (IVIg) are commonly used in a variety of diseases, including inflammatory and autoimmune disorders. Although usually well-tolerated, various adverse effects have been reported. DIAM is a serious neurological side effect of IVIg therapy: albeit rare (0.067% of all IVIg infusions), the condition represents an important diagnostic challenge and should be considered by physicians. Here we report a case of an aseptic meningitis induced by IVIg therapy in a child with acute Epstein-Barr virus (EBV) infection and thrombocytopenia.
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Affiliation(s)
- Paolo Vassalini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | | | | | - Jacopo Vergari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Cecilia Tosato
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Giulia Savelloni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy
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14
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Caraffa E, Russo G, Vita S, Lichtner M, Massetti AP, Mastroianni CM, Vullo V, Ciardi MR, Ajassa C. Intracranial tuberculous mass lesions treated with thalidomide in an immunocompetent child from a low tuberculosis endemic country: A case report. Medicine (Baltimore) 2018; 97:e11186. [PMID: 30024502 PMCID: PMC6086519 DOI: 10.1097/md.0000000000011186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Tuberculous meningitis is a highly morbid, often fatal disease. PATIENT CONCERN We describe a case of an Italian child. DIAGNOSES:: we diagnosed early a Tuberculous meningitis complicated by the occurrence of hydrocephalus, stroke, and paradoxical reaction with brain pseudo-abscesses. INTERVENTIONS The child started readily a specific therapy associated with steroids and thalidomide was introduced few month later. OUTCOMES the patient had a favorable outcome without neurologic sequelae. LESSONS Despite the prompt specific anti-tubercular and adjuvant corticosteroid therapies, only the addition of thalidomide to the treatment allow to a favorable clinical outcome.
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Affiliation(s)
- Emanuela Caraffa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome
| | - Gianluca Russo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome
| | - Serena Vita
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome
| | - Miriam Lichtner
- Infectious Diseases Unit, Sapienza University, SM Goretti Hospital, Latina, Italy
| | - Anna Paola Massetti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome
| | - Maria Rosa Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome
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15
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Lichtner M, Rossi R, Vita S, Savinelli S, Iannetta M, Mascia C, Marocco R, Ajassa C, Mengoni F, Scorzolini L, Maria Mastroianni C, Vullo V. Blood Myeloid Dendritic Cells and slanDC in Antiretroviral Therapy- Suppressed HIV-Infected Patients. Curr HIV Res 2017; 14:331-9. [PMID: 26785889 DOI: 10.2174/1570162x14666160120152100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/23/2015] [Accepted: 01/12/2016] [Indexed: 11/22/2022]
Abstract
Myeloid dendritic cells (mDCs) play a complex role in HIV infection regardless of viral replication. The aim of our study was to analyse mDCs in long term antiretroviral therapy (ART)- suppressed HIV-infected patients. We evaluated the numbers of mDCs and slanDC in the context of different degree of CD4+ T cell recovery, persistent T cell activation (as HLA-DR+/CD3+ expression) and monocyte-macrophage activation assessed in terms of circulating levels of both sCD14 and sCD163. We enrolled 72 aviremic patients under effective ART and 34 healthy donors (HD). Patients were divided into two groups on the bases of ΔCD4, indicating the difference between the value of CD4 at the time of sampling and CD4 nadir. Higher levels of mDCs and slanDC were found in patients with ΔCD4>200/mmc in comparison to HD. In those patients also an increased level of sCD14 was found, whereas sCD163 seemed to be at normal levels. An augmentation of activated CD4 T lymphocytes was found, although less pronounced in patients with ΔCD4<200/mmc. In conclusion, our findings showed an expansion of mDCs with a shift to inflammatory slanDC that could sustain both microbial translocation and HIV latency in CD4 T cells.
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Affiliation(s)
| | - Raffaella Rossi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy. Piazzale Aldo Moro 5, 00155, Rome, Italy
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16
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Vita S, Ajassa C, Caraffa E, Lichtner M, Mascia C, Mengoni F, Paglia MG, Mancarella C, Colistra D, Di Biasi C, Ciardi RM, Mastroianni CM, Vullo V. Immunological diagnosis as an adjunctive tool for an early diagnosis of tuberculous meningitis of an immune competent child in a low tuberculosis endemic country: a case report. BMC Res Notes 2017; 10:123. [PMID: 28288691 PMCID: PMC5347815 DOI: 10.1186/s13104-017-2444-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pediatric tuberculous meningitis is a highly morbid, often fatal disease. Its prompt diagnosis and treatment saves lives, in fact delays in the initiation of therapy have been associated with high mortality rates. CASE PRESENTATION This is a case of an Italian child who was diagnosed with tuberculous meningitis after a history of a month of headache, fatigue and weight loss. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis with predominance and decreased glucose concentration. Microscopy and conventional diagnostic tests to identify Mycobacterium tuberculosis were negative, while a non classical method based on intracellular cytokine flow cytometry response of CD4 cells in cerebral spinal fluid helped us to address the diagnosis, that was subsequently confirmed by a nested polymerase chain reaction amplifying a 123 base pair fragment of the M. tuberculosis DNA. CONCLUSIONS We diagnosed tuberculous meningitis at an early stage through an innovative immunological approach, supported by a nested polymerase chain reaction for detection of M. tuberculosis DNA. An early diagnosis is required in order to promptly initiate a therapy and to increase the patient's survival.
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Affiliation(s)
- Serena Vita
- Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy.
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy
| | - Emanuela Caraffa
- Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy
| | - Miriam Lichtner
- Department of Public Health and Infectious Diseases, Sapienza University, Polo Pontino, 04100, Latina, Italy
| | - Claudia Mascia
- Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy
| | - Fabio Mengoni
- Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy
| | - Maria Grazia Paglia
- Microbiology Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani, 00149, Rome, Italy
| | - Cristina Mancarella
- Department of Neurology and Psychiatry, Division of Neurosurgery, Sapienza, 00185, Rome, Italy
| | - Davide Colistra
- Department of Neurology and Psychiatry, Division of Neurosurgery, Sapienza, 00185, Rome, Italy
| | - Claudio Di Biasi
- Department of Emergency and Acceptance, Unit of Radiology, Policlinico Umberto I, Rome, Italy
| | - Rosa Maria Ciardi
- Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy
| | - Claudio Maria Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, Polo Pontino, 04100, Latina, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University, 00185, Rome, Italy
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Vita S, Tebano G, Rossomando AM, De RA, Cavallari EN, Caraffa E, Ajassa C, Vullo V. High prevalence of gallbladder involvement during hepatitis: An outbreak in a paediatric population. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jmld2015.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ermocida A, Mengoni F, Sauzullo I, Rossi R, Ajassa C, Lichtner M, Mastroianni CM, Vullo V. Extravirologic modulation of immune response by an NRTI-sparing antiretroviral regimen including darunavir and maraviroc. New Microbiol 2014; 37:225-229. [PMID: 24858650] [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] [Received: 08/28/2013] [Accepted: 02/09/2014] [Indexed: 06/03/2023]
Abstract
Dual therapies, including protease inhibitor + maraviroc (MVC), may represent an alternative to traditional regimens for management of HIV infection. The aim of this in vitro study was to assess the effects of darunavir (DRV) alone or in combination with MVC on cell apoptosis and chemotaxis. A significant decrease of cell apoptosis was found after DRV treatment. The addition of MVC to DRV also had an in vitro down-regulating effect on cell migration. The combination of an NRTI-sparing regimen including DRV+ MVC may have a potential role in immune system modulation by the direct down regulation of apoptosis and chemotaxis.
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Affiliation(s)
- Angela Ermocida
- Department of Public Health and Infectious Diseases, Sapienza University, Istituto Pasteur-Fondazione Cenci-Bolognetti, Rome, Italy
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19
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Esposito A, Floridia M, d'Ettorre G, Pastori D, Fantauzzi A, Massetti P, Ceccarelli G, Ajassa C, Vullo V, Mezzaroma I. Rate and determinants of treatment response to different antiretroviral combination strategies in subjects presenting at HIV-1 diagnosis with advanced disease. BMC Infect Dis 2011; 11:341. [PMID: 22166160 PMCID: PMC3297656 DOI: 10.1186/1471-2334-11-341] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 12/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The optimal therapeutic strategies for patients presenting with advanced disease at HIV-1 diagnosis are as yet incompletely defined. METHODS All patients presenting at two outpatient clinics in 2000-2009 with an AIDS-defining clinical condition or a CD4+ T cell count < 200/μL at HIV-1 diagnosis were analyzed for the presence of combined immunovirological response, defined by the concomitant presence of an absolute number of CD4+ T cells > 200 cells/μL and a plasma HIV-1 RNA copy number < 50/mL after 12 months of HAART. RESULTS Among 102 evaluable patients, first-line regimens were protease inhibitors [PI]-based in 78 cases (77%) and efavirenz-based in 24 cases (23%). The overall response rate was 65% (95% CI: 55-74), with no differences by gender, age, nationality, route of transmission, hepatitis virus coinfections, presence of AIDS-defining clinical events, baseline HIV-1 viral load, or type of regimen (response rates with PI-based and efavirenz-based therapy: 63% and 71%, respectively, p = 0.474). Response rate was significantly better with higher baseline CD4+ T cell counts (78% with CD4+ ≥ 100/μL, compared to 50% with CD4+ < 100/μL; odds ratio: 3.5; 95% CI: 1.49-8.23, p = 0.003). Median time on first-line antiretroviral therapy was 24 months (interquartile range: 12-48). Switch to a second line treatment occurred in 57% of patients, mainly for simplification (57%), and was significantly more common with PI-based regimens [adjusted hazard ratios (AHR) with respect to efavirenz-based regimens: 3.88 for unboosted PIs (95% CI: 1.40-10.7, p = 0.009) and 4.21 for ritonavir-boosted PI (95% CI 1.7-10.4, p = 0.002)] and in older subjects (≥ 50 years) (AHR: 1.83; 95% CI: 1.02-3.31, p = 0.044). Overall mortality was low (3% after a median follow up of 48 months). CONCLUSIONS Our data indicate that a favorable immunovirological response is possible in the majority of naive patients presenting at HIV-1 diagnosis with AIDS or low CD4+ T cell counts, and confirm that starting HAART with a more compromised immune system may be associated with a delayed and sometimes partial immune recovery. Simpler regimens may be preferable in this particular population.
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Affiliation(s)
| | - Marco Floridia
- Dpt. of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriella d'Ettorre
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Pastori
- Dpt. of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Rome, Italy
| | | | - Paola Massetti
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Giancarlo Ceccarelli
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Camilla Ajassa
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Vullo
- Dpt. of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Dpt. of Clinical Medicine, "Sapienza" University of Rome, Rome, Italy
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Sauzullo I, Mengoni F, Lichtner M, Rossi R, Ajassa C, Rizza M, Mastroianni C, Vullo V. UTILIZZO DEL QUANTIFERON (QF)-TB GOLD IN UNA COORTE DI SOGGETTI PEDIATRICI E HIV POSITIVI. Microbiol Med 2006. [DOI: 10.4081/mm.2006.3163] [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: 11/23/2022] Open
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21
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Ciervo A, Mastroianni CM, Ajassa C, Pinto A, Ciceroni L. Rapid identification of Bartonella henselae by real-time polymerase chain reaction in a patient with cat scratch disease. Diagn Microbiol Infect Dis 2005; 53:75-7. [PMID: 16054323 DOI: 10.1016/j.diagmicrobio.2005.04.006] [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] [Received: 01/05/2005] [Accepted: 04/16/2005] [Indexed: 11/20/2022]
Abstract
We report a localized submandibular lymph node infection in a patient with cat scratch disease. Directly performing real-time polymerase chain reaction assay on the biopsy sample, Bartonella henselae DNA was simultaneously detected and identified.
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Affiliation(s)
- Alessandra Ciervo
- Department of Infectious, Parasitic, and Immune-Mediated Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy.
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22
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Ciardi M, Giacchetti G, Fedele CG, Tenorio A, Brandi A, Libertone R, Ajassa C, Borgese L, Delia S. Acute cerebellitis caused by herpes simplex virus type 1. Clin Infect Dis 2003; 36:e50-4. [PMID: 12539091 DOI: 10.1086/345781] [Citation(s) in RCA: 21] [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] [Received: 07/01/2002] [Accepted: 10/14/2002] [Indexed: 01/01/2023] Open
Abstract
Cerebellar disorders due to herpes simplex virus (HSV) infection are rare and always associated with herpes simplex encephalitis. We report 2 cases of severe primary acute cerebellitis caused by HSV type 1 that were identified by nested polymerase chain reaction performed on cerebrospinal fluid samples.
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Affiliation(s)
- Maria Ciardi
- Department of Infectious and Tropical Diseases, University La Sapienza, 00161 Rome, Italy.
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23
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Di Nardo R, Marziale P, Ajassa C, Tzantzoglou S, De Nuzzo MG, Drudi FM, David V. [Role of sonography in the evaluation of parotid gland in HIV+ children undergone highly active antiretroviral therapy (HAART)]. Radiol Med 2001; 102:138-42. [PMID: 11677455] [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: 02/22/2023]
Abstract
PURPOSE To evaluate the role of sonography (US) in the evaluation of parotid gland alterations in HIV+ children, in order to show their presence, severity, specificity, relationship with clinical and laboratory data and sensitivity to new drugs. MATERIAL AND METHODS From June 2000 to December 2000 twenty-two consecutive HIV+ children (12 males and 10 females, mean age 9.7) undergoing HAART were prospectively examined with US. A multi-frequency linear probe (7.5-10 MHz) was used for the examination. The glands were assessed for alterations in gland volume and vasculature, hypoechoic foci, hyperechoic striae, lympho-epithelial cysts and solid nodules and the enlargement of intraparotid and adjacent lympho nodes. The US findings on HIV+ patients were compared with the patients'clinical and laboratory data and with US exams performed on HIV- children. Finally, we made a comparison with US exams performed on the same patients before HAART: RESULTS In HIV+ children the most frequent US findings were hypoechoic foci (68.2% of patients), hyperechoic striae (68.2%) and the enlargement of intraparotid and adjacent lympho nodes (86.3% and 95.4%, respectively). No relationship between US outline and clinical and laboratory data was found. In the control group (HIV-negative children) hypoechoic foci and hyperechoic striae were rare (4.7% and 14.3%, respectively), while the enlargement of intraparotid and adjacent lympho nodes was very common (76.2% and 100%, respectively). The comparison with US exams performed on the same patients before HAART showed an improvement in 59.1% of patients, no improvement in 13.6% and a worsening in 13.6% (3 patients were lost to follow-up). DISCUSSION AND CONCLUSIONS US is useful in the study of parotid gland alterations in HIV+ children. The most frequent specific US findings were hypoechoic foci and hyperechoic striae, whereas the enlargement of intraparotid and adjacent lympho nodes was frequent but completely aspecific. The analysis of results did not show any relationship between the US findings and clinical and laboratory data. HAART can be correlated to an improvement and/or a stabilization of the US pattern in most patients.
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Affiliation(s)
- R Di Nardo
- Istituto di Radiologia Centrale, Azienda Ospedaliera Policlinico Umberto I, Università degli Studi La Sapienza, Rome, Italy.
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24
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Castello MA, Catania N, Ajassa C. [The HIV-positive child]. Recenti Prog Med 2000; 91:59-62. [PMID: 10748647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- M A Castello
- Istituto di Clinica Pediatrica Università La Sapienza, Roma
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25
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Catania S, Mascellino MT, Ajassa C, Berardelli G, Bellagamba R, Tzanzoglou S, Iegri F, Ronchetti MP, Catania N. Incidence of bacterial colonization in the throat and in urines at paediatric age with evaluation of sensitivity to common antibiotics. Riv Eur Sci Med Farmacol 1996; 18:169-72. [PMID: 9177617] [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: 02/04/2023]
Abstract
OBJECTIVES To evaluate the incidence of bacterial colonization in the throat and in urines of children admitted to a paediatric ward in the year 1994. To test the sensitivity of isolates on the most common antibiotics used in therapy. METHODS The investigation was carried out on a group of 270 children (125 male and 145 female), aged between 3 months and 12 years, hospitalized with feverish infectious pathology in the department of infectious and Tropical Diseases of the University "La Sapienza" of Rome. The cultures of the throat swabs and on urines were performed on the admission of the children before the beginning of the therapy. RESULTS The throat-swab cultures showed pathogenous microrganisms in 232 samples (85.9%) with a slight prevalence of Gram-negative bacteria (122) with respect to Gram-positive (110) and saprophytic microbial flora (38). The urine cultures proved to be positive in 81 cases (30%) with a prevalence of Gram-negative (56) above Gram-positive isolates (25). CONCLUSIONS The two/thirds of paediatric patients hospitalized in an Infectious Diseases Department appeared to be colonized in the upper respiratory tract, whereas in about 10% of them a marked bacteriuria was clearly evident, often in the absence of specific symptoms. A few isolates either from the throat or from urines, showed resistance to the common antibacterial agents.
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Affiliation(s)
- S Catania
- Department of Infectious and Tropical Diseases, La Sapienza University of Rome
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26
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Catania S, Ronchetti MP, Catania N, Berardelli G, D'Aviera L, Rossi F, Mannozzi P, Tzanzoglou S, Bellagamba R, Ajassa C. Hemophilus influenzae type b meningitis: pediatric overview. Riv Eur Sci Med Farmacol 1996; 18:163-7. [PMID: 9177616] [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: 02/04/2023]
Abstract
The authors valued the incidence and clinical therapeutic aspects of Haemophilus influenzae type b (Hib) meningitis in children. They report a retrospective study, in children, with diagnosis of acute purulent meningitis, from January 1982 to December 1994, aged between 1 month and 14 years. Particular attention was direct to Haemophilus influenzae type b meningitis (20 cases). The incidence rate of Hib meningitis in the overall cases (89) was 22.47% (20), while among children younger than 5 years Hib was the most frequently pathogen isolated (20/58-34.47%). In 1/4 of cases, particularly in children younger than 1 years, exordium was aspecific and unclear. At admission culture and examination of Cerebrospinal Fluid (CFS) have been done. CFS was cultured on blood agar and chocolate plates. A latex agglutination test was used for rapid detection of the bacterial antigens. In some cases we looked for bacterial antigens in urine. 20% of children had complications and 10% had sequelae (1 years of follow-up). We didn't have any dead. Antibiotic treatment was principally with Ampicillin, Cephalosporin and Chloramphenicol. The results of this study confirm the Hib gravity and suggest that the administration of conjugate vaccine against Hib to all living in Italy is justified.
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Affiliation(s)
- S Catania
- Department of Infectious and Tropical Diseases, La Sapienza, University of Rome
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27
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Catania S, Ajassa C, Tzantzoglou S, Bellagamba R, Berardelli G, Catania N. [Seroepidemiologic study of the prevalence of anti-HAV antibodies in children in Rome]. Riv Eur Sci Med Farmacol 1996; 18:7-9. [PMID: 8766776] [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: 05/22/2023]
Abstract
The authors evaluated the incidence of infection by hepatitis A virus (HAV) in a paediatric population through a seroepidemiological investigation in a group of 278 children (0-12 years old), apparently healthy. The determination of anti-HAV antibodies was carried out by ELISA-test. Of the 287 examined sera, 27 cases turned out HAV positive antibodies (9.7%), with the following distribution, according to the groups of age: 0-3 months: 2 of 6 children were positive (mother's antibodies); 3 months-2 years: 6 of 112 (5.35%); 2-6 years: 10 of 93 (10.75%); 6-12 years: 11 of 67 (16.41%). With regard to distribution of anti-HAV antibodies by sex, 23 (15.03%) males of 153 resulted positive, whereas 4 (3.2%) females of 125 resulted positive. The decline of HAV infection in the paediatric age involves a possible shift of the risk to the adult age. It's advisable that the vaccination against hepatitis A in first period should be reserved for the subjects at risk and later both for unweaned and children in order to eradicate the infection.
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Affiliation(s)
- S Catania
- Dipartimento di Malattie Infettive e Tropicali dell Università degli Studi La Sapienza, Roma
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28
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Catania S, Ajassa C, Magno MS, Berardelli G, Bellagamba R, Tzantzoglou S, Falciano M, Lanzalone CM, Catania N. [Acyclovir in the treatment of varicella in immunocompetent children]. Riv Eur Sci Med Farmacol 1995; 17:115-23. [PMID: 8545564] [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: 01/31/2023]
Abstract
We evaluated safety and tolerance of acyclovir ACV per os in immunocompetent children affected by chicken-pox admitted to our department from January 1993 to December 1994. 183 subjects (102 males and 81 females) aged between 0 and 14 years were treated by ACV (80 mg/kg/daily in 4 divided doses): 88 children were treated within 24 hours and 95 subjects within 48 hours from the onset of symptoms. The control group consisted of 83 children (52 males and 31 females) aged between 0 to 14 years. In all patients routine blood-test were performed and in those with respiratory illness Chest-Rx was also done. We evaluated clinical course, degree of eruption, the appearance and kind of complications, duration of hospitalization, the compliance and the potential consequences on specific antibody response. Our results show a faster improvement of clinical symptoms in treated patients with respect to the control group with shortening of the period of the fever, itch and appearance of new vescicles. The percentage of complications was lower in treated than in untreated patients. 16 cases tested for specific antibody response showed protective titers six months after treatment. In conclusion, ACV administered per os within 48 hours from onset of exanthema causes reduction of the period and the degree of general symptoms and exanthema, a lower incidence of complications even if non statistically significant. The drug is safe and well-tolerated.
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Affiliation(s)
- S Catania
- Dipartimento di Malattie Infettive e Tropicali, Università degli Studi La Sapienza, Roma
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29
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Mastroianni CM, Sebastiani G, Folgori F, Ajassa C, Vullo V, Volpi A. Detection of cytomegalovirus-matrix protein (pp65) in leukocytes of HIV-infected patients with painful peripheral neuropathy. J Med Virol 1994; 44:172-5. [PMID: 7852958 DOI: 10.1002/jmv.1890440210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [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: 01/27/2023]
Abstract
Painful peripheral neuropathy (PPN) in HIV-infected patients has been increasingly associated with cytomegalovirus (CMV) infection at other sites. In the last few years, the detection of CMV lower matrix phosphoprotein (pp65) antigen in leukocytes has become a major tool in the diagnosis of CMV systemic infection in immunocompromised patients. In this study, CMV antigen detection was assessed in 13 HIV-infected patients with PPN and, as controls, in 82 HIV seropositive patients without any evidence of peripheral nerve syndromes (10 with CMV retinitis and 72 without CMV end-organ disease). CMV antigenemia was found in 10 (76.9%) patients with PPN, in 5 (6.9%) without CMV disease, and in all 10 patients (100%) with CMV retinitis. Of the 10 PPN patients with CMV antigenemia, only 3 presented with CMV retinitis, while the remaining 7 had no clinical evidence of overt CMV infection at other sites. CMV pp65-positive cells were also found in three of the four cerebrospinal fluid (CSF) samples collected from PPN patients. Ganciclovir was effective in improving neurological symptoms in two of the four treated patients. The findings suggest that active CMV infection may be associated with PPN in HIV infection even in the absence of CMV disease at other sites. The detection of CMV-matrix pp65 antigen in the blood and CSF leukocytes could represent a simple and rapid tool of selecting PPN patients for antiviral therapy.
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Affiliation(s)
- C M Mastroianni
- Institute of Infectious Diseases, La Sapienza University, Rome, Italy
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30
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Ajassa C, Angelici AM, Rendina E, Trinchieri V, Berardelli G, Bellagamba R, Catania N, Falciano M, Mascellino MT, Causo T. [Clinical-therapeutic considerations in a case of miliary tuberculosis in an indonesian girl]. Riv Eur Sci Med Farmacol 1993; 15:175-80. [PMID: 7761666] [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
The authors describe the case of widespread miliary tuberculosis, that arose in a ten year-old Indonesian girl of middle-class, who has been living in Italy from about three years. The girl was probably contaminated by a subject belonging to the same ethnic-social community, who was affected with tubercular disease. The diagnosis was effected on the ground of: clinical picture including continued-remitting fever, a loose cough, asthenia, anorexia, weight reduction, aching tumefaction on the left side of the neck; isolation of Mycobacterium tuberculosis from the expectoration, blood, urine, and a lymph node located on the left side of the neck; radiological picture that revealed a widespread miliary tuberculosis. In spite of polychemotherapy with isoniazid , rifampicin, pirazinamide, and streptomycin that was subsequently replaced by ethambutol, the course of the illness worsened and it was characterized with fever, cachexia, respiratory insufficiency and repeated episodes of pneumothorax. For such reasons on the ground of susceptibility to the antibiogram amikacin and ciprofloxacin, as well as glucocorticoids to limit the fibrousness, were added to the specific therapy that was already being out. For persisting of relapsing pneumothoraxes, the patient underwent a thoracoscopy and plerodesis with talcum powder. After four months of antitubercular therapy, the research of M. tuberculosis resulted negative in the expectoration, urine, bronchus-alveolar washing liquid and blood, in addition to improvement in general state of health with remission of fever was noticed.
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Affiliation(s)
- C Ajassa
- Istituto Malattie Infettive, Università La Sapienza, Roma
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31
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Catania S, Ajassa C, Summonti D, Del Grosso B, Causo T, Catania N, Berardelli C, Fabietti P, Trinchieri V, Bellagamba R. [Clinical-therapeutic considerations in pertussis]. Riv Eur Sci Med Farmacol 1992; 14:261-4. [PMID: 1306003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
One-hundred and seventy-one cases of pertussis were observed at the Institute of Infections Diseases and at the 2nd Division of Infectious Diseases of the Policlinico Umberto I in Rome from January 1, 1987 to June 30, 1991. All subjects were treated according to a therapeutic protocol consisting of macrolides (erythromycin or myocamicin) at doses of 40-50 mg/die, betamethasone 0.1 mg/kg/die, specific immunoglobulin G at doses of 0.5 ml/kg repeated after 24 hours (new born babies and babies still unweaned) and oxygen therapy during the paroxystic fits. In 20 patients who were over the first year of life and who had serious asphyxiated fits, bronchodilators (trimetochinol or salbutamol) were added to the previous therapeutic scheme. Our data show both efficacy of therapeutic protocol and importance of early starting the treatment to shorten the length of disease, the strength of asphyxiated fits, and the risk of contagion.
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Affiliation(s)
- S Catania
- Istituto di Malattie Infettive, Università La Sapienza, Roma
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