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Paolucci M, Gentile L, Gentile M, Borghi A, Merli E, Marchionni E, Guerra L, Galluzzo S, Cilloni N, Simonetti L, Zini A. Progressive multifocal leukoencephalopathy in multiple myeloma: a case report of a patient with SARS-CoV-2 infection and an updated systematic literature review. Neurol Sci 2023; 44:2995-2998. [PMID: 37421487 DOI: 10.1007/s10072-023-06944-0] [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: 03/23/2023] [Accepted: 07/04/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by a reactivation of the human polyomavirus 2 (HPyV-2, previously known as JCV) in immunosuppressed individuals. Few cases of PML have been described in multiple myeloma (MM) patients. METHODS We described a case of PML in a patient with MM with fatal worsening that occurred during SARS-CoV-2 infection. We also performed a literature review to update the 16 cases series of MM patients with PML already collected until April 2020. RESULTS A 79-year-old female patient with refractory IgA lambda MM in Pomalidomide- Cyclophosphamide-Dexamethasone regimen developed gradual lower limbs and left arm paresis along with a decreased consciousness 3.5 years after the MM diagnosis. Symptoms developed shortly after the recognition of hypogammaglobulinemia. After SARS-CoV-2 infection, her neurological status quickly worsened until she deceased. MRI features and JCV-positive PCR on CSF confirmed the PML diagnosis. Our literature review adds sixteen clinical cases of PML in MM published between May 2020 and March 2023 to the 16 cases already collected in the previously published review by Koutsavlis. DISCUSSION PML has been increasingly described in MM patients. It remains questionable if the HPyV-2 reactivation is determined by the severity of MM itself, by the effect of drugs or by a combination of both. SARS-CoV-2 infection may have a role in worsening PML in affected patients.
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Affiliation(s)
- Matteo Paolucci
- UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Largo Bartolo Nigrisoli, 2, Bologna, 40133, Italy.
| | - Luana Gentile
- UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Largo Bartolo Nigrisoli, 2, Bologna, 40133, Italy
| | - Mauro Gentile
- UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Largo Bartolo Nigrisoli, 2, Bologna, 40133, Italy
| | - Annamaria Borghi
- UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Largo Bartolo Nigrisoli, 2, Bologna, 40133, Italy
| | - Elena Merli
- UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Largo Bartolo Nigrisoli, 2, Bologna, 40133, Italy
| | - Elisa Marchionni
- Infectious Disease Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna Bologna, Bologna, Italy
| | - Luca Guerra
- Infectious Disease Unit, Department for Integrated Infectious Risk Management, IRCCS Azienda Ospedaliero-Universitaria di Bologna Bologna, Bologna, Italy
| | - Simone Galluzzo
- UOSI Neuroradiologia Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Nicola Cilloni
- Intensive Care Unit, Maggiore Hospital, AUSL Bologna, Bologna, Italy
| | - Luigi Simonetti
- UOSI Neuroradiologia Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Andrea Zini
- UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, IRCCS Istituto delle Scienze Neurologiche di Bologna, Largo Bartolo Nigrisoli, 2, Bologna, 40133, Italy
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Amadesi S, Virgili G, Marchionni E, Cascavilla A, Lazzarotto T, Viale P, Gaibani P. Severe Escherichia coli infections in critical adult patients: two case reports and genomic analysis. New Microbiol 2023; 46:24-28. [PMID: 36853814] [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] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 02/28/2023] [Indexed: 03/01/2023]
Abstract
Pathogenic Escherichia coli strains can infect a variety of body sites due to the expression of virulence factors necessary to overcome the host defenses. Here, we present two cases of E. coli infection in adults and discuss the associated genomic features. Whole-genome sequencing was performed using both Illumina iSeq 100 and Oxford Nanopore MinION systems. Assembly was carried out with Unicycler using a hybrid approach. The genomes were annotated with RASTtk and scanned for genes involved in antimicrobial resistance, virulence and stress response with AMRFinderPlus. Sequence analysis was conducted using tools from the Center for Genomic Epidemiology (CGE) website. The two strains, named SO80 and SO81, carried a genome of 5,229,956 and 5,437,935 base pairs, respectively. SO80 belonged to ST70 and carried 13 virulence factors, 6 of which were located on a 170 Kb plasmid, while SO81 belonged to ST69 and carried 29 virulence factors, 5 of which were located on a 113 Kb plasmid. Our work highlights key factors which may have contributed to the complicated clinical status of these patients, and provides new in-depth data on E. coli infections with few precedents in the literature.
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Affiliation(s)
- Stefano Amadesi
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Giulio Virgili
- Division of Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Elisa Marchionni
- Division of Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Alessandra Cascavilla
- Division of Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Tiziana Lazzarotto
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.,University of Bologna
| | - Pierluigi Viale
- Division of Infectious Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.,University of Bologna
| | - Paolo Gaibani
- Division of Microbiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
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3
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Marconi L, Tedeschi S, Zamparini E, Terzi S, Rossi N, Boriani L, Trapani F, Giannella M, Ruinato DA, Marchionni E, Gasbarrini A, Viale P. Oral versus standard antimicrobial treatment for pyogenic native vertebral osteomyelitis: a single center, retrospective, propensity score balanced analysis. Open Forum Infect Dis 2022; 9:ofac366. [PMID: 35959206 PMCID: PMC9361174 DOI: 10.1093/ofid/ofac366] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Interest toward shorter antimicrobial regimens and oral treatment for osteoarticular infections is growing. The aim of this study is to assess whether there is an association between the administration of an entirely oral antibiotic therapy (OT) and the clinical outcome of native vertebral osteomyelitis (NVOs).
Methods
Single center, retrospective, observational study on consecutive patients with pyogenic NVOs over a 10-year period (2008-2018). Multivariate logistic regression analysis was carried out to identify risk factors for clinical failure, both in the whole population and in subgroups. The impact of OT versus standard treatment (intravenous induction followed by oral treatment whenever possible) was assessed in patients with a non-multidrug resistant microorganism (MDRO) etiology and the impact of a rifampin-containing regimen was assessed in patients affected by NVOs caused by staphylococci or of unknown etiology.
Results
Study population included 249 patients, 33 (13.3%) experienced clinical failure; OT group consisted of 54 patients (21.7%). Multivariate regression analysis of the whole population selected Charlson Comorbidity Index (aOR 1.291, 95% CI 1.114-1.497, p = 0.001) and MDRO etiology (aOR 3.301, 95% CI 1.368-7.964, p = 0.008) as independent factors for clinical failure. Among patients affected by a non-MDRO NVO, OT was not associated with an increased risk of clinical failure (aOR 0.487, 95% CI 0.133-1.782, p value = 0.271), even after adjustment for the propensity score of receiving OT. In the subgroup of patients with staphylococcal or unknown etiology NVO rifampin was independently associated with favorable outcome (aOR 0.315, 95% CI 0.105-0.949, p value = 0.040)
Conclusions
An entirely oral, highly bioavailable treatment, including rifampin, may be as effective as parenteral treatment in selected patients with NVOs.
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Affiliation(s)
- Lorenzo Marconi
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Sara Tedeschi
- Correspondence: S. Tedeschi, MD, Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy ()
| | - Eleonora Zamparini
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Silvia Terzi
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Nicolò Rossi
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Luca Boriani
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Filippo Trapani
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Maddalena Giannella
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Elisa Marchionni
- Infectious Disease Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncological and Degenerative Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Pascale R, Pasquini Z, Bartoletti M, Caiazzo L, Fornaro G, Bussini L, Volpato F, Marchionni E, Rinaldi M, Trapani F, Temperoni C, Gaibani P, Ambretti S, Barchiesi F, Viale P, Giannella M. Cefiderocol treatment for carbapenem-resistant Acinetobacter baumannii infection in the ICU during the COVID-19 pandemic: a multicentre cohort study. JAC Antimicrob Resist 2021; 3:dlab174. [PMID: 34806011 PMCID: PMC8599913 DOI: 10.1093/jacamr/dlab174] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [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: 08/09/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
Objectives To analyse the impact of cefiderocol use on outcome in patients admitted to the ICU for severe COVID-19 and further diagnosed with carbapenem-resistant Acinetobacter baumannii (CR-Ab) infection. Methods Retrospective multicentre observational study was performed at four Italian hospitals, from January 2020 to April 2021. Adult patients admitted to ICU for severe COVID-19 and further diagnosed with CR-Ab infections were enrolled. Patients treated with cefiderocol, as compassionate use, for at least 72 h were compared with those receiving alternative regimens. Primary endpoint was all-cause 28 day mortality. The impact of cefiderocol on mortality was evaluated by multivariable Cox regression model. Results In total, 107 patients were enrolled (76% male, median age 65 years). The median time from ICU admission to CR-Ab infection diagnosis was 14 (IQR 8–20) days, and the main types of CR-Ab infections were bloodstream infection (58%) and lower respiratory tract infection (41%). Cefiderocol was administered to 42 patients within a median of 2 (IQR 1–4) days after CR-Ab infection diagnosis and as monotherapy in all cases. The remaining patients received colistin, mostly (82%) administered as combination therapy. All-cause 28 day mortality rate was 57%, without differences between groups (cefiderocol 55% versus colistin 58% P = 0.70). In multivariable analysis, the independent risk factor for mortality was SOFA score (HR 1.24, 95% CI 1.15–1.38, P < 0.001). Cefiderocol was associated with a non-significant lower mortality risk (HR 0.64, 95% CI 0.38–1.08, P = 0.10). Conclusions Our study confirms the potential role of cefiderocol in the treatment of CR-Ab infection, but larger clinical studies are needed.
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Affiliation(s)
- Renato Pascale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Zeno Pasquini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Michele Bartoletti
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Luca Caiazzo
- Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giacomo Fornaro
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Linda Bussini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Francesca Volpato
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Elisa Marchionni
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Matteo Rinaldi
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Filippo Trapani
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Chiara Temperoni
- Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Gaibani
- Operative Unit of Microbiology, University of Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Simone Ambretti
- Operative Unit of Microbiology, University of Bologna, Policlinico Sant'Orsola, Bologna, Italy
| | - Francesco Barchiesi
- Infectious Disease Unit, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy.,Department of Scienze Biomediche e Sanità Pubblica, Università Politecnica delle Marche, Ancona, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant'Orsola, Bologna, Italy
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5
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Potalivo A, Montomoli J, Facondini F, Sanson G, Lazzari Agli LA, Perin T, Cristini F, Cavagna E, De Giovanni R, Biagetti C, Panzini I, Ravaioli C, Bitondo MM, Guerra D, Giuliani G, Mosconi E, Guarino S, Marchionni E, Gangitano G, Valentini I, Giampaolo L, Muratore F, Nardi G. Sixty-Day Mortality Among 520 Italian Hospitalized COVID-19 Patients According to the Adopted Ventilatory Strategy in the Context of an Integrated Multidisciplinary Clinical Organization: A Population-Based Cohort Study. Clin Epidemiol 2020; 12:1421-1431. [PMID: 33408529 PMCID: PMC7779307 DOI: 10.2147/clep.s278709] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 08/25/2020] [Accepted: 12/07/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Although the decision of which ventilation strategy to adopt in COVID-19 patients is crucial, yet the most appropriate means of carrying out this undertaking is not supported by strong evidence. We therefore described the organization of a province-level healthcare system during the occurrence of the COVID-19 epidemic and the 60-day outcomes of the hospitalized COVID-19 patients according to the respiratory strategy adopted given the limited available resources. Patients and Methods All COVID-19 patients (26/02/2020–18/04/2020) in the Rimini Province of Italy were included in this population-based cohort study. The hospitalized patients were classified according to the maximum level of respiratory support: oxygen supplementation (Oxygen group), non-invasive ventilation (NIV-only group), invasive mechanical ventilation (IMV-only group), and IMV after an NIV trial (IMV-after-NIV group). Sixty-day mortality risk was estimated with a Cox proportional hazard analysis adjusted by age, sex, and administration of steroids, canakinumab, and tocilizumab. Results We identified a total of 1,424 symptomatic patients: 520 (36.5%) were hospitalized, while 904 (63.5%) were treated at home with no 60-day deaths. Based on the respiratory support, 408 (78.5%) were assigned to the Oxygen group, 46 (8.8%) to the NIV-only group, 25 (4.8%) to the IMV-after-NIV group, and 41 (7.9%) to the IMV-only group. There was no significant difference in the PaO2/FiO2 at IMV inception in the IMV-after-NIV and IMV-only groups (p=0.9). Overall 60-day mortality was 24.2% (Oxygen: 23.0%; NIV-only: 19.6%; IMV-after-NIV: 32.0%; IMV-only: 36.6%; p=0.165). Compared with the Oxygen group, the adjusted 60-day mortality risk significantly increased in the IMV-after-NIV (HR 2.776; p=0.024) and IMV-only groups (HR 2.966; p=0.001). Conclusion This study provided a population-based estimate of the impact of the COVID-19 outbreak in a severely affected Italian province. A similar 60-day mortality risk was found for patients undergoing immediate IMV and those intubated after an NIV trial with favorable outcomes after prolonged IMV.
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Affiliation(s)
- Antonella Potalivo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Jonathan Montomoli
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Francesca Facondini
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Gianfranco Sanson
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Luigi Arcangelo Lazzari Agli
- Department of Pneumology, Infermi Hospital, Rimini, Italy.,Ceccarini Hospital, AUSL della Romagna, Riccione, Italy
| | - Tiziana Perin
- Department of Emergency Medicine, Infermi Hospital, AUSL Della Romagna, Rimini, Italy
| | - Francesco Cristini
- Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Enrico Cavagna
- Department of Radiology, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Raffaella De Giovanni
- Department of Internal Medicine, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy
| | - Carlo Biagetti
- Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Ilaria Panzini
- Department of Clinical Research, AUSL della Romagna, Ravenna, Italy
| | - Cinzia Ravaioli
- Ausl della Romagna Health Care Service Direction, Ravenna, Italy
| | - Maria Maddalena Bitondo
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Daniela Guerra
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Giovanni Giuliani
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Elena Mosconi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Sonia Guarino
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Elisa Marchionni
- Department of Infectious Diseases, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Gianfilippo Gangitano
- Department of Emergency Medicine, Infermi Hospital, AUSL Della Romagna, Rimini, Italy
| | - Ilaria Valentini
- Department of Pneumology, Infermi Hospital, Rimini, Italy.,Ceccarini Hospital, AUSL della Romagna, Riccione, Italy
| | - Luca Giampaolo
- Department of Internal Medicine, Cervesi Hospital, AUSL della Romagna, Cattolica, Italy
| | - Francesco Muratore
- Department of Radiology, Infermi Hospital, AUSL della Romagna, Rimini, Italy
| | - Giuseppe Nardi
- Department of Anaesthesia and Intensive Care, Infermi Hospital, AUSL della Romagna, Rimini, Italy
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Marchionni E, Marconi L, Ruinato D, Zamparini E, Gasbarrini A, Viale P. Spondylodiscitis: is really all well defined? Eur Rev Med Pharmacol Sci 2020; 23:201-209. [PMID: 30977887 DOI: 10.26355/eurrev_201904_17494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The term spondylodiscitis describes the infection of both the intervertebral disc space and the adjacent vertebrae. Pyogenic Vertebral Osteomyelitis (PVO) is more common in older patients (mean age 59-69 years) with a male preponderance (52-69%). Recent studies reported an alarming increase of incidence over the last 20 years, due to the increase of diagnostic sensibility, the increase of the average lifetime and to the consequent association of chronic disabling pathologies, of immunosuppression, of surgical or invasive procedure. Improvements in radiological diagnosis, surgical techniques, and management of antimicrobial therapy have greatly improved PVO clinical outcome, but morbidity remains significant mostly because of the delay of diagnosis. The non-specific features of this infection can lead to underestimate the patient conditions, ending to a significant delay in diagnosis, reported from 30 to 90 days, and consequently to severe impairments, such as spine deformity and permanent neurological deficit. The duration of medical treatment is not yet established, and further randomized trials are needed to define it.
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Affiliation(s)
- E Marchionni
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
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Marchionni E, Parize P, Lefevre A, Vironneau P, Bougnoux ME, Poiree S, Coignard-Biehler H, DeWolf SE, Amazzough K, Barchiesi F, Jullien V, Alanio A, Garcia-Hermoso D, Wassef M, Kania R, Lortholary O, Lanternier F. Aspergillus spp. invasive external otitis: favourable outcome with a medical approach. Clin Microbiol Infect 2016; 22:434-7. [PMID: 26802213 DOI: 10.1016/j.cmi.2015.12.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 09/09/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 01/08/2023]
Abstract
Aspergillus spp. invasive external otitis (IEO) is a rare infection. We performed a seven-year, single-centre retrospective study from 2007 to 2014 including all patients with proven Aspergillus spp. IEO. Twelve patients were identified. All patients had a poorly controlled diabetes mellitus and one underwent solid organ transplant. The most frequently isolated species was Aspergillus flavus (n = 10) and voriconazole was the first-line therapy in all cases, with a median length of treatment of 338.5 days (158-804 days). None of the patients underwent extensive surgery. The clinical outcome was excellent. However, otological sequelae were reported, including hearing impairment (n = 7) and facial palsy (n = 3).
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Affiliation(s)
- E Marchionni
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Infectious Diseases Department, Marche Polytechnic University, Ancona, Italy
| | - P Parize
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - A Lefevre
- Department of Radiology, Necker-Enfants Malades Hospital, Paris, France
| | - P Vironneau
- Department of Oto-Rhino-Laryngology, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - M E Bougnoux
- Microbiology Laboratory, Necker-Enfants Malades Hospital, Paris Descartes University, Paris, France; Biology and Pathogenicity Unit, Institut Pasteur, Paris, France
| | - S Poiree
- Department of Radiology, Necker-Enfants Malades Hospital, Paris, France
| | - H Coignard-Biehler
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - S E DeWolf
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - K Amazzough
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France
| | - F Barchiesi
- Infectious Diseases Department, Marche Polytechnic University, Ancona, Italy
| | - V Jullien
- Department of Pharmacology, Paris Descartes University, Sorbonne Paris Cité, Inserm U1129, Hôpital Européen Georges-Pompidou, Paris, France
| | - A Alanio
- Parasitology-Mycology Laboratory, Lariboisière-Saint Louis Hospital, Paris, France
| | - D Garcia-Hermoso
- Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France
| | - M Wassef
- Department of Pathology, Faculty of Medicine, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - R Kania
- Department of Oto-Rhino-Laryngology, Lariboisière Hospital, Paris Diderot University, Paris, France
| | - O Lortholary
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France; Institut Pasteur, Unite de Mycologie Moleculaire, CNRS URA3012, Paris, France
| | - F Lanternier
- Paris Descartes University, Infectious Diseases and Tropical Medicine Department, Necker Pasteur Infectious Diseases Centre, Necker-Enfants Malades Hospital, APHP, IHU Imagine, Paris, France; Institut Pasteur, Centre National de Référence Mycoses invasives et Antifongiques, Paris, France; Institut Pasteur, Unite de Mycologie Moleculaire, CNRS URA3012, Paris, France.
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Brescini L, Orsetti E, Gesuita R, Piraccini F, Marchionni E, Staffolani S, Castelli P, Drenaggi D, Barchiesi F. Evaluating Liver Fibrosis by Transient Elastometry in Patients With HIV-HCV Coinfection and Monoinfection. Hepat Mon 2014; 14:e15426. [PMID: 25337140 PMCID: PMC4199183 DOI: 10.5812/hepatmon.15426] [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] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/23/2013] [Accepted: 02/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Due to the high efficacy of combination antiretroviral therapy (cART), the number of patients living with HIV is increasing. Chronic HCV infection has become a leading cause of non-AIDS related morbidity and mortality in patients with HIV infection. OBJECTIVES The aim of this cross-sectional study was to identify factors associated with liver fibrosis (LF) in patients with HIV monoinfection and HIV-HCV coinfection. PATIENTS AND METHODS We analyzed LF by transient elastometry ([TE], Fibroscan) in three groups of patients (HIV, HIV-HCV and HCV) followed at the Infectious Diseases Department of University of Ancona, Italy, between October 2009 and November 2012. RESULTS In total, 354 adults including 98 HIV, 70 HIV-HCV and 186 HCV patients were studied. HIV-HCV patients had a longer duration of HIV (P < 0.006) and HCV (P < 0.001) infections. Additionally, they were receiving cART therapy for a longer period (P < 0.001); they had higher prevalence of lipodystrophy (P < 0.001) and higher HCV load (P = 0.004). LF was significantly more pronounced in HCV and HIV-HCV compared to HIV patients (P < 0.001). A total of 13.3%, 39.2% and 51.4% of HIV, HCV and HIV-HCV, respectively, showed a LF ≥ F2. Additionally, a severe LF (F = 4) was significantly more frequent among HIV-HCV compared to other groups. A longer exposure to didanosine, stavudine, lopinavir/ritonavir and fosamprenavir resulted in increased LF by univariate analysis (P ranging from < 0.001 to 0.007). By logistic regression analysis, the only variables significantly associated with increased LF were HCV coinfection, older age, and high AST values (P ranging from < 0.001 to 0.036). CONCLUSIONS HCV coinfection, older age and AST were associated with LF in patients with HIV infection.
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Affiliation(s)
- Lucia Brescini
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Elena Orsetti
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Rosaria Gesuita
- Centre for Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Francesca Piraccini
- Centre for Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Elisa Marchionni
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Silvia Staffolani
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Pamela Castelli
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Davide Drenaggi
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Francesco Barchiesi
- Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy
- Corresponding Author: Francesco Barchiesi, Department of Biomedical Sciences and Public Health, Clinical Infectious Diseases, Polytechnic University of Marche, Ancona, Italy. Tel: +39-715963466, Fax: +39-715963468, E-mail:
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Mazzocato S, Marchionni E, Fothergill AW, Sutton DA, Staffolani S, Gesuita R, Skrami E, Fiorentini A, Manso E, Barchiesi F. Epidemiology and outcome of systemic infections due to saprochaete capitata: case report and review of the literature. Infection 2014; 43:211-5. [PMID: 25078793 DOI: 10.1007/s15010-014-0668-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
Abstract
A case of systemic infection due to Saprochaete capitata in a patient with chronic lymphocytic leukemia is described. A review of the literature was conducted to identify all reported cases of this infection described between 1977 and August 2013. One hundred and four cases (included the present one) were identified. The median age of the patients was 56 years and 56% were males. Comorbidities included acute myeloid leukemia (52%), acute lymphoid leukemia (22%), other hematological malignancies (13%) and non-hematological diseases (9%). At the time of the infection, 82% of the patients were neutropenic. In 75% of the cases, the yeast was isolated from blood culture, in 25% from other sterile sites. Empirical treatment was done in 36% of the cases. Fifty-eight percent of the individual cases were treated with a combination or a sequential antifungal therapy. Amphotericin B was the antifungal drug most commonly used, followed by voriconazole and itraconazole. The overall crude mortality was 60%. Saprochaete capitata causes life-threatening infections in neutropenic patients. This comprehensive literature review may help the clinician to optimize the management of this rare infection.
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Affiliation(s)
- S Mazzocato
- Clinica Malattie Infettive, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Umberto I-Lancisi-Salesi, Via Conca, Torrette di Ancona, 60020, Ancona, Italy
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Gabrielli E, Fothergill AW, Brescini L, Sutton DA, Marchionni E, Orsetti E, Staffolani S, Castelli P, Gesuita R, Barchiesi F. Reply to Ma et al.: osteomyelitis caused by Aspergillus species. Clin Microbiol Infect 2014; 20:O788. [PMID: 24593271 DOI: 10.1111/1469-0691.12613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- E Gabrielli
- Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy
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Gabrielli E, Fothergill AW, Brescini L, Sutton DA, Marchionni E, Orsetti E, Staffolani S, Castelli P, Gesuita R, Barchiesi F. Osteomyelitis caused by Aspergillus species: a review of 310 reported cases. Clin Microbiol Infect 2013; 20:559-65. [PMID: 24303995 DOI: 10.1111/1469-0691.12389] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/31/2013] [Accepted: 08/31/2013] [Indexed: 11/30/2022]
Abstract
Aspergillus osteomyelitis is a rare infection. We reviewed 310 individual cases reported in the literature from 1936 to 2013. The median age of patients was 43 years (range, 0-86 years), and 59% were males. Comorbidities associated with this infection included chronic granulomatous disease (19%), haematological malignancies (11%), transplantation (11%), diabetes (6%), pulmonary disease (4%), steroid therapy (4%), and human immunodeficiency virus infection (4%). Sites of infection included the spine (49%), base of the skull, paranasal sinuses and jaw (18%), ribs (9%), long bones (9%), sternum (5%), and chest wall (4%). The most common infecting species were Aspergillus fumigatus (55%), Aspergillus flavus (12%), and Aspergillus nidulans (7%). Sixty-two per cent of the individual cases were treated with a combination of an antifungal regimen and surgery. Amphotericin B was the antifungal drug most commonly used, followed by itraconazole and voriconazole. Several combination or sequential therapies were also used experimentally. The overall crude mortality rate was 25%.
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Affiliation(s)
- E Gabrielli
- Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy
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Orsetti E, Staffolani S, Gesuita R, De Iaco G, Marchionni E, Brescini L, Castelli P, Barchiesi F. Changing characteristics and risk factors of patients with and without incident HCV infection among HIV-infected individuals. Infection 2013; 41:987-90. [PMID: 23703287 DOI: 10.1007/s15010-013-0465-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/16/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection has become a leading cause of non-acquired immunodeficiency syndrome (AIDS)-related morbidity and mortality for human immunodeficiency virus (HIV)-infected persons in the highly active antiretroviral therapy (HAART) era. Despite injection drug use (IDU) remaining the main route of HCV infection, recent reports indicate outbreaks of acute HCV infection among HIV-infected men who have sex with men (MSM) and sexually transmitted infections in the absence of IDU. METHODS We conducted a retrospective observational study of behavioural and demographic factors of patients with and without incident HCV infection among HIV-infected individuals followed at the AIDS Clinic of the Infectious Disease Department of the University of Ancona from 1989 to 2011. RESULTS Overall, 440 patients were considered; a total of 145 patients had initial positive HCV antibody test results (HCV+); a total of 295 patients had initial negative HCV antibody test results (HCV-). In the latter population, 14 seroconverted to HCV antibody (neoHCV), with an overall incidence of 0.59 per 100 person-years. While IDU was the principal risk factor of HCV+, the main route of transmission of incident HCV infection was sexual transmission. The HCV- group was significantly older than the other two groups and showed a significantly lower CD4 count at HIV diagnosis than neoHCV. Being Italian and having a low level of education were significantly more represented in HCV+. Younger age at HIV infection, IDU and additional risk factors other than sexual transmission significantly affected the probability of being HCV+. The cumulative probability of developing HCV infection in the HCV- group was calculated to be 6% at 15 years. CONCLUSIONS The epidemiology of the newly acquired HCV in HIV+ persons is changing. Therefore, a frequent and constant counselling about HCV infection is desirable and a periodical screening test is mandatory.
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Affiliation(s)
- E Orsetti
- Clinica Malattie Infettive, Università Politecnica delle Marche, Ancona, Italy
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Cirioni O, Kamysz E, Ghiselli R, Kamysz W, Silvestri C, Orlando F, Rimini M, Brescini L, Gabrielli E, Marchionni E, Rocchi M, Provinciali M, Guerrieri M, Giacometti A. Lipopeptide Laur-CKK-NH2 dimer preserves daptomycin susceptibility and enhances its activity against Enterococcus faecalis. J Antimicrob Chemother 2011; 66:859-62. [DOI: 10.1093/jac/dkr001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Cirioni O, Mocchegiani F, Ghiselli R, Silvestri C, Gabrielli E, Marchionni E, Orlando F, Nicolini D, Risaliti A, Giacometti A. Daptomycin and rifampin alone and in combination prevent vascular graft biofilm formation and emergence of antibiotic resistance in a subcutaneous rat pouch model of staphylococcal infection. Eur J Vasc Endovasc Surg 2011; 40:817-22. [PMID: 20869272 DOI: 10.1016/j.ejvs.2010.08.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the efficacy of daptomycin and rifampin either alone or in combination in preventing prosthesis biofilm in a rat model of staphylococcal vascular graft infection. DESIGN Prospective, randomised, controlled animal study. MATERIALS Graft infections were established in the back subcutaneous tissue of adult male Wistar rats by implantation of Dacron prostheses followed by topical inoculation with 2×10(7) colony forming units of Staphylococcus aureus, strain Smith diffuse. METHODS The study included a control group, a contaminated group that did not receive any antibiotic prophylaxis and three contaminated groups that received intra-peritoneal daptomycin, rifampin-soaked graft and daptomycin plus rifampin-soaked graft, respectively. Each group included 15 animals. The infection burden was evaluated by using sonication and quantitative agar culture. Moreover, an in vitro antibiotic susceptibility assay for S. aureus biofilms was performed to elucidate the same activity. RESULTS When tested alone, daptomycin and rifampin showed good efficacies. Their combination showed efficacies significantly higher than that of each single compound. The in vitro studies showed that minimum inhibitory concentration and minimum bactericidal concentration values for daptomycin were lower in presence of rifampin. Daptomycin prevented the emergence of rifampin resistance. CONCLUSION Daptomycin is an important candidate for prevention of staphylococcal biofilm-related infection and rifampin could serve as an interesting anti-staphylococcal antibiotic enhancer.
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Affiliation(s)
- O Cirioni
- Clinic of Infectious Diseases, Università Politecnica delle Marche-Ospedali Riuniti, Ancona, Italy.
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