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Pinchera B, Viceconte G, Buonomo AR, Zappulo E, Mercinelli S, Moriello NS, Cattaneo L, Scotto R, Giaccone A, Avallone RC, Tosone G, Gentile I. Epidemiological and clinical features of syphilis in the 21st century: A seven-year observational retrospective study of outpatients. Clinical Epidemiology and Global Health 2022. [DOI: 10.1016/j.cegh.2022.101100] [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: 11/30/2022] Open
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Imperatore N, Foggia M, Patturelli M, Rispo A, Calabrese G, Testa A, Pellegrini L, Tosone G, Di Luna I, Nardone OM, Ricciolino S, Castiglione F. Treatment-based risk stratification of infections in inflammatory bowel disease: A comparison between anti-tumor necrosis factor-α and nonbiological exposure in real-world setting. J Gastroenterol Hepatol 2021; 36:1859-1868. [PMID: 33283312 DOI: 10.1111/jgh.15367] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/29/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Infective issues about anti-tumor necrosis factor (TNF)-α agents in inflammatory bowel disease (IBD) remain controversial, especially when compared with nonbiological treatments. This study aimed to evaluate the incidence and prevalence of several infections in anti-TNF-α-exposed patients compared with nonbiological treatments. METHODS All naïve IBD subjects treated with anti-TNF-α and matched nonbiologic-exposed patients were included. RESULTS Among 3453 patients in the database, 288 anti-TNF-α-exposed subjects and 288 nonbiologic-exposed IBD controls met inclusion criteria. Fifty-eight infections (20.1%) occurred during anti-TNF-α treatment versus 23 (8%) in the matched group (odds ratio [OR] 2.9, P < 0.001) (incidence 5.72 vs 0.96/100 patient-years, incidence ratio [IR] 6, P < 0.001). IR was higher for anti-TNF-α versus mesalamine/sulfasalazine (IR 40.8, P < 0.001), similar to azathioprine/6-mercaptopurine/methotrexate (IR 0.78, P = 0.32) and lower than corticosteroids (IR 0.05, P < 0.001). The incidence rate of serious infections was 1.3 in the anti-TNF-α-exposed versus 0.38/100 patient-years in nonexposed subjects (IR 3.44, P = 0.002), without significant difference between anti-TNF-α and azathioprine/6-mercaptopurine/methotrexate (1.3 vs 3.03/100 patient-years, IR 0.43, P = 0.1). Predictors of infections in anti-TNF-α-exposed patients were concomitant use of systemic steroids (OR 1.9, P = 0.02) or azathioprine (OR 2.6, P = 0.01) and a body mass index < 18.5 at time of infection (OR 2.2, P = 0.01). CONCLUSIONS The risk of developing infections during anti-TNF-α therapy remains high, although not dissimilar to that found for other immunosuppressants, while concomitant immunosuppression and malnutrition appear the most important causes of infection.
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Affiliation(s)
- Nicola Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy.,Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Maria Foggia
- Department of Infectious Diseases, School of Medicine Federico II of Naples, Naples, Italy
| | - Marta Patturelli
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Giulio Calabrese
- Department of Infectious Diseases, School of Medicine Federico II of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Lucienne Pellegrini
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Grazia Tosone
- Department of Infectious Diseases, School of Medicine Federico II of Naples, Naples, Italy
| | - Imma Di Luna
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Olga Maria Nardone
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
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Buonomo AR, Scotto R, Coppola C, Pinchera B, Viceconte G, Rapillo CM, Staiano L, Saturnino M, Scarano F, Portunato F, Pisaturo M, De Pascalis S, Martini S, Tosone G, Nappa S, Coppola N, Gentile I. Direct acting antivirals treatment for hepatitis C virus infection does not increase the incidence of de novo hepatocellular carcinoma occurrence: Results from an Italian real-life cohort (LINA cohort). Medicine (Baltimore) 2020; 99:e18948. [PMID: 32028404 PMCID: PMC7015572 DOI: 10.1097/md.0000000000018948] [Citation(s) in RCA: 4] [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] [Indexed: 02/06/2023] Open
Abstract
The effectiveness of direct-acting antivirals (DAAs) against hepatitis C virus (HCV) infection is ascertained. However, some authors raised the issue of an increased incidence of de novo hepatocellular carcinoma (HCC) in patients treated with DAAs. Aim of the study was to evaluate the rate of HCC occurrence in a real-life cohort of patients who received anti-HCV treatment with DAAs.A prospective multicentre study was conducted. All adult patients with HCV infection who received treatment between March 2015 and December 2017 in 4 hospital of Campania region (South Italy) with at least 6 months of follow-up were enrolled.A total of 323 patients were included in the study. Most patients had HCV genotype 1b (61.8%). The overall SVR12 rate was 95.5%. Median time of observation was 10 months. The incidence rate of HCC was 0.2 per 100 person-months (crude incidence rate 3.4%, 95 confidence interval: 1.5%-5.3%). The median time for HCC occurrence was 11 months. HCC occurrence rate was significantly higher among patients who did not achieve SVR12 compared with patients who did (28.6% vs 2.8%, P < 0.05). No patient with F0-F3 fibrosis developed HCC. Among patients with cirrhosis, at the multivariate time-to-event analysis, no covariates were independently associated with the risk of HCC occurrence.Treatment with DAAs did not increase the risk of HCC occurrence. Patients who achieved SVR12 had a lower rate of HCC occurrence. Further studies are needed to estimate the incidence and the risk for HCC in the long-term follow-up among patients undergoing treatment with DAAs.
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Affiliation(s)
- Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Carmine Coppola
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Giulio Viceconte
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Costanza Maria Rapillo
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Laura Staiano
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Mariarosaria Saturnino
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Ferdinando Scarano
- Department of Internal Medicine - Unit of Hepatology and Interventional Ultrasonography. OORR Area Stabiese, Plesso Nuovo Gragnano, Naples
| | - Federica Portunato
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Stefania De Pascalis
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Salvatore Martini
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Salvatore Nappa
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
| | - Nicola Coppola
- Department of Mental Health and Public Medicine – Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery – Section of Infectious Diseases, University of Naples Federico II
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Zappulo E, Buonomo AR, Saccà F, Russo CV, Scotto R, Scalia G, Nozzolillo A, Lanzillo R, Tosone G, Gentile I. Incidence and Predictive Risk Factors of Infective Events in Patients With Multiple Sclerosis Treated With Agents Targeting CD20 and CD52 Surface Antigens. Open Forum Infect Dis 2019; 6:ofz445. [PMID: 31723572 PMCID: PMC6837838 DOI: 10.1093/ofid/ofz445] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/03/2019] [Accepted: 10/08/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Monoclonal antibodies (MAbs) directed against the CD20 and CD52 antigens are used increasingly in patients with multiple sclerosis (MS). Several life-threatening opportunistic infections have been reported in postmarketing case series. The aim of this study was to investigate the incidence of infections and associated prognostic factors during the first year of treatment in patients receiving anti-CD20 (ocrelizumab or rituximab) or anti-CD52 MAbs (alemtuzumab). METHODS A retrospective study was conducted in patients with MS referring to the Neurodegenerative Diseases Center at the University of Naples Federico II who received MAbs between November 2015 and June 2018. RESULTS A total of 163 patients were enrolled. Approximately 40% of patients experienced lymphocytopenia during treatment. Eighty-six infective events were reported in 67 patients (41%). Bacterial infections were significantly more frequent with anti-CD20, whereas viral infections prevailed with alemtuzumab. Cytomegalovirus reactivation rates were significantly higher in the alemtuzumab group than in patients on anti-CD20 (51% vs 6%, P < .001). The overall annualized infection rate was 1.1 per patient-year, higher in patients on anti-CD52 versus those on anti-CD20 regimens (1.5 vs 0.8 per patient-year). Alemtuzumab treatment, prior exposure to ≥2 MS drugs, and iatrogenic immune impairment significantly and independently predicted an infection event (adjusted hazard ratio [aHR], 2.7; P = .013; aHR, 1.7; P = .052; and aHR, 2.9; P = .004; respectively). CONCLUSIONS Given their considerable infection risk, MS patients receiving MAbs should undergo timely follow up and tailored preventive interventions. Anti-CD52-based treatment, prior exposure to MS drugs, and on-treatment immune impairment are significant predictive factors of infection and their evaluation could help clinicians to stratify a patient's risk of infection.
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Affiliation(s)
- Emanuela Zappulo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Antonio Riccardo Buonomo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Francesco Saccà
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Cinzia Valeria Russo
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Riccardo Scotto
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Giulia Scalia
- Clinical and Experimental Cytometry Unit, CEINGE-Biotecnologie Avanzate, Naples, Italy
| | - Agostino Nozzolillo
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Roberta Lanzillo
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
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Santarpia L, Viceconte G, Foggia M, Alfonsi L, Tosone G, Camera L, Pagano MC, De Simone G, Contaldo F, Pasanisi F. Home Parenteral Nutrition in Patients with Intestinal Failure: Possible Undetected Complications. Nutrients 2019; 11:nu11030581. [PMID: 30857281 PMCID: PMC6471421 DOI: 10.3390/nu11030581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Septic pulmonary embolism (SPE) may be a frequently undetected complication of central venous catheter (CVC)-related bloodstream infections (CRBSIs). Materials and Methods: The incidence of SPE was evaluated in a cohort of non-oncological patients on home parenteral nutrition (HPN) who were hospitalized for a CRBSI from January 2013 to December 2017. The main clinical, microbiological, and radiological features and the therapeutic approach were also described. Results: Twenty-three infections over 51,563 days of HPN therapy were observed, corresponding to an infection rate of 0.45/1000. In 10 out of the 23 cases (43.5%), pulmonary lesions compatible with SPE were identified. Conclusion: Our results demonstrated that a CRBSI can produce asymptomatic SPE with lung infiltrates in 43.5% of the cases, suggesting the need to check for secondary lung infections to choose the most appropriate antimicrobial therapy.
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Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Giulio Viceconte
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Foggia
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Grazia Tosone
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Luigi Camera
- Radiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Giuseppe De Simone
- Anesthesiology and Intensive Care Unit, Department of Neurosciences, Federico II University, 80131 Naples, Italy.
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
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Bianco V, Spera AM, Maraolo AE, Parente S, Donno D, Schiano Moriello N, Tosone G. Risk of professional accidental exposure to biological agents in health care workers: a retrospective analysis carried out in a southern Italian tertiary hospital. Infez Med 2019; 27:40-45. [PMID: 30882377] [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
Worldwide the needlestick injuries of health care workers (HCWs) still represent a major health problem. The authors aimed to evaluate the risk of HCW needlestick injuries in a tertiary university hospital in southern Italy in relation to some HCW characteristics (age, sex, professional profile, work department) and the source of infection. All HCWs of the University Hospital "Federico II" in Naples, Italy, attending the Infectious Diseases Unit after potential accidental contact to blood-borne viruses through needlestick injuries were enrolled during a 22-year period. HCWs underwent clinical analysis and were administered a specific questionnaire to collect (in anonymous fashion) data about age, sex, professional profile and work department. From 1995 to 2016 1,477 needlestick injuries in the same number of people (one accident per person) were recorded by our service. The HCWs were predominately males (n = 806, 55%) and the mean age was 39.4 years (±10.1 SD). The job categories most involved were: physicians (41%), followed by nurses (33%) and healthcare assistants (HCAs, 10%). The incidence proportion was calculated for these highest-risk categories in three defined time points (at the beginning, in the middle and at the end of the study period): 104/2149 (4.86%) in 1995, 41/2498 (1.64%) in 2005 and 25/2057 (1.22%) in 2015. Most injuries occurred in General Surgery (14.21%), Gynecology and Obstetrics (9%) and Pediatrics (6.49%). In about 34% the HCWs had been exposed to HCV infected fluids. Over time, a significant decrease in accidental exposure was recorded for physicians (p= 0.019), nurses (p< 0.0001) and HCAs (p< 0.0001). Our results confirm that some profiles, namely physicians, nurses and healthcare assistants, are still at risk of needlestick injuries, especially in surgical areas, including obstetric wards. Further primary and secondary prevention strategies are needed to decrease the incidence of new cases of needlestick injuries.
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Affiliation(s)
- Vincenzo Bianco
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University Federico II of Naples, Italy
| | - Anna Maria Spera
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University Federico II of Naples, Italy
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University Federico II of Naples, Italy
| | - Serena Parente
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University Federico II of Naples, Italy
| | - Davide Donno
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University Federico II of Naples, Italy
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University Federico II of Naples, Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University Federico II of Naples, Italy
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Bianco V, Spera AM, Simeone D, Tosone G, Orlando R. An update on epidemiology of congenital rubella syndrome: how far from the World Health Organization goals? Minerva Med 2019; 108:483-485. [PMID: 28728344 DOI: 10.23736/s0026-4806.17.05103-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Vincenzo Bianco
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy -
| | - Anna M Spera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | | | - Grazia Tosone
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
| | - Raffaele Orlando
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy
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Parente S, Moriello NS, Maraolo AE, Tosone G. Management of chickenpox in pregnant women: an Italian perspective. Eur J Clin Microbiol Infect Dis 2018; 37:1603-1609. [PMID: 29802481 PMCID: PMC7101639 DOI: 10.1007/s10096-018-3286-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/15/2018] [Indexed: 01/30/2023]
Abstract
Chickenpox is a highly contagious disease caused by primary infection of varicella zoster virus (VZV). The disease is spread worldwide and is usually benign but, in some groups of population like pregnant women, can have a severe outcome. Due to a not optimal vaccination coverage, a relatively high number of childbearing-aged women in a European country such as Italy tested seronegative for VZV and so are currently at risk of acquiring chickenpox during pregnancy, especially if they live in contact with children for family or work reasons. Only few data are available about the risk of infection in this setting: the incidence of chickenpox may range from 1.5 to 4.6 cases/1000 childbearing females and from 1.21 to 6 cases/10,000 pregnant women, respectively. This review is aimed to focus on the epidemiology and the clinical management of exposure to chickenpox during pregnancy. Particular emphasis is given to the accurate screening of childbearing women at the time of the first gynecological approach - the females who tested susceptible to infection can be counseled about the risks and instructed on procedure should contact occur - and to the early prophylaxis of the at-risk exposure. Lastly, the achievement of adequate vaccination coverage of the Italian population remains a cornerstone in the prevention of chickenpox in pregnancy.
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Affiliation(s)
- Serena Parente
- Department of Clinical Medicine and Surgery- Section of Infectious Diseases, University Federico II of Naples, Naples, Italy.
| | - Nicola Schiano Moriello
- Department of Clinical Medicine and Surgery- Section of Infectious Diseases, University Federico II of Naples, Naples, Italy
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery- Section of Infectious Diseases, University Federico II of Naples, Naples, Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery- Section of Infectious Diseases, University Federico II of Naples, Naples, Italy
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Tosone G, Simeone D, Spera AM, Viceconte G, Bianco V, Orlando R. Epidemiology and pathogenesis of fulminant viral hepatitis in pregnant women. Minerva Obstet Gynecol 2017; 70:480-486. [PMID: 28994560 DOI: 10.23736/s0026-4784.17.04107-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The pregnancy-associated immunological and hormonal changes may alter the immune response to infectious agents, including hepatitis viruses. Therefore, this phenomenon may affect the clinical course and the outcome of acute viral hepatitis in pregnant women. EVIDENCE ACQUISITION For this reason, we have focused on epidemiological and pathogenetic aspects of the fulminant liver failure caused by acute viral hepatitis reviewing PubMED in April of 2017. EVIDENCE SYNTHESIS Although all the viruses might cause a fulminant acute viral hepatitis in a pregnant woman, the large majority of fulminant failure reported in the literature had been related to hepatits E virus (HEV) mainly and had been concentrated in Indian subcontinent and some African areas, whereas the problem seems to be very low or absent in the remaining geographical areas. However, the rate of maternal mortality due to fulminant E hepatitis may vary inside the endemic areas of India and Africa, likely due to the circulation of HEV genotypes with different degree of virulence. The other hepatitis viruses have not been reported to cause a greater risk for fulminant hepatitis in pregnant women respect to non-pregnant ones, except Herpes simplex virus, that has been associated to some cases of fatal hepatitis in absence of a prompt antiviral therapy. CONCLUSIONS AVH should be considered when the pregnant woman develop fever, abdominal pain, malaise, nausea and anicteric hepatic dysfunction.
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Affiliation(s)
- Grazia Tosone
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy -
| | - Davide Simeone
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Anna M Spera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Giulio Viceconte
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Vincenzo Bianco
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Raffaele Orlando
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
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Viceconte G, Maraolo AE, Iula VD, Catania MR, Tosone G, Orlando R. Appropriateness of antibiotic prescription for targeted therapy of infections caused by multidrug-resistant bacteria: assessment of the most common improper uses in a tertiary hospital in southern Italy. Infez Med 2017; 25:224-233. [PMID: 28956539] [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: 06/07/2023]
Abstract
A huge proportion of antibiotic therapies for infections caused by multidrug-resistant bacteria (MDR) are inappropriate. In this study, we described the most common causes of inappropriateness of definitive antibiotic regimes in a large university hospital in southern Italy and we evaluated the impact on microbial eradication, length of stay, 30-day readmission and mortality. We retrospectively assessed 45 patients who received a definitive antibiotic therapy after isolation of multidrug-resistant Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp. strains between 2014 and 2015. From the literature, we set a series of criteria to retrospectively determine the appropriateness of the therapy. In all, 61% of the prescribed antibiotic regimes were found to be inappropriate, especially due to incorrect drug dosage. It emerged that meropenem was the antibiotic most frequently inappropriately used. In 46% of infections caused by MDR but not extended-spectrum β-lactamase-producing Enterobacteriaceae, carbapenems were inappropriately administered. Microbial eradication was achieved in 87% of the appropriate therapy group compared to 31% of the inappropriate therapy group (chi-square=6.750, p<0.027). No statistically significant association was found between inappropriate therapy and the length of stay (chi-square=3.084, p=0.101) and 30-day readmission (p=0.103). Definitive antibiotic therapy in infections caused by multidrug-resistant bacteria in a large university hospital is often inappropriate, especially due to the drug dosing regimen, particularly in the case of meropenem and colistin. This inappropriateness has a significant impact on post-treatment microbial eradication in specimens collected after antibiotic therapy.
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Affiliation(s)
- Giulio Viceconte
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alberto Enrico Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Vita Dora Iula
- Section of Clinical Microbiology, Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Maria Rosaria Catania
- Section of Clinical Microbiology, Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
| | - Grazia Tosone
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Raffaele Orlando
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Costantino A, Coppola N, Spada E, Bruni R, Taffon S, Equestre M, Marcantonio C, Sagnelli C, Dell'Isola C, Tosone G, Mascolo S, Sagnelli E, Ciccaglione AR. Hepatitis A virus strains circulating during 1997-2015 in Campania, a Southern Italy region with periodic outbreaks. J Med Virol 2017. [PMID: 28621437 DOI: 10.1002/jmv.24880] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In Italy, the incidence of hepatitis A has progressively declined over the last 30 years, though not homogeneously throughout the country. In Campania, Southern Italy, high annual incidence rates have been reported and several periodic outbreaks have occurred. To investigate the phylogenetic and epidemiologic relationships among HAV strains circulating in Campania over the period 1997-2015, 87 hepatitis A cases were investigated. The most frequent risk factor was the consumption of raw/undercooked shellfish (75/87, 86.2%). During 1997-2002 most viral strains were subtype IA (16/23, 70%); the phylogenetic pattern suggests that the incidence peaks observed in 2000-2001 had likely been caused by multiple strains. During a large 2004 outbreak, almost all viral variants were subtype IB (38/41, 93%); most of them (22/38, 58%) were recognized to be one of two main strains (differing for just a single nucleotide), the remaining sequences were strictly related variants. In 2014/2015, only IA strains were observed; two phylogenetically related but distinct strains were responsible, respectively, for a small cluster in 2014 and an outbreak in 2015. In each outbreak, several strains unrelated to those responsible for most cases were detected in a minority of patients, documenting a background of sporadic cases occurring even in the course of outbreaks; some of them proved to be identical to strains detected 11-14 years previously. Overall, the data suggest that several related and unrelated HAV strains have endemically circulated over the last 15 years in Campania, with some strains gaining epidemic transmission likely because of a local combination of multiple factors, including inadequate waste water purification and dietary habits.
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Affiliation(s)
- Angela Costantino
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
| | - Enea Spada
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Bruni
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefania Taffon
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Michele Equestre
- Department of Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Cinzia Marcantonio
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Caterina Sagnelli
- Department of Experimental Medicine and Surgery F. Magrassi and A. Lanzara, Second University of Naples, Naples, Italy
| | - Chiara Dell'Isola
- Department of Infectious Diseases-Section of Hepatic Emergencies, Cotugno Hospital, Naples, Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Viral Infection and AIDS Unit, Naples, Italy
| | - Silvia Mascolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Viral Infection and AIDS Unit, Naples, Italy
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Naples, Italy
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12
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Kamal Eldin T, Tosone G, Capuano A, Orlando R. Reversible Hypokalemia and Bartter-Like Syndrome during Prolonged Systemic Therapy with Colistimethate Sodium in an Adult Patient. Drug Saf Case Rep 2017; 4:10. [PMID: 28699114 PMCID: PMC5505885 DOI: 10.1007/s40800-017-0052-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present the case of a 58-year-old woman who developed hypokalaemia and metabolic alkalosis 2 weeks after therapy with colistimethate sodium for the treatment of chronic lower limb ulcer infection by extensively drug-resistant (XDR) Pseudomonas aeruginosa. The metabolic changes observed resembled Bartter syndrome, a group of congenital disorders affecting the distal segments of the renal tubules. The metabolic abnormalities reversed spontaneously 6 days after drug discontinuation. Acquired forms of Bartter syndrome have been reported during courses of antibiotic therapy; however, to our knowledge, this is the first documented case associated with colistimethate therapy in an adult.
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Affiliation(s)
- Tarek Kamal Eldin
- Section of Viral Diseases, Department of Clinical Medicine, University Hospital 'Federico II' of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Grazia Tosone
- Section of Viral Diseases, Department of Clinical Medicine, University Hospital 'Federico II' of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Alfredo Capuano
- Section of Haemodialysis Techniques and Peritoneal Dialysis, Department of Specialty Surgery and Nephrology, University Hospital 'Federico II' of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Raffaele Orlando
- Section of Viral Diseases, Department of Clinical Medicine, University Hospital 'Federico II' of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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13
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Cerchione C, Maraolo AE, Marano L, Pugliese N, Nappi D, Tosone G, Cimmino I, Cozzolino I, Martinelli V, Pane F, Picardi M. Secondary syphilis mimicking malignancy: A case report and review of literature. J Infect Chemother 2017; 23:576-578. [PMID: 28456488 DOI: 10.1016/j.jiac.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/03/2016] [Revised: 01/27/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
A 56-year-old man developed disseminate lymphadenopathies, associated with hepato-splenomegaly, fever, nocturnal sweating and weight loss. Imaging studies in particular FDG-PET/CT raised the suspicion of a malignant disease. But blood flow cytometry assay for B/T cell clonality was negative and fine-needle biopsy of enlarged laterocervical lymph node showed a not specific "reactive hyperplasia". Four months later, the patient developed a non-itching rash; since a further anamnestic investigation revealed an history of high-risk sexual intercourse, the patient underwent serological tests for Treponema pallidum that were positive at high titer, after a first negative screening. Made the diagnosis of secondary syphilis, the patient responded to the treatment with benzyl penicillin with complete resolution of symptoms. This case highlights the importance of carefully screening the patients with suspected lymphoadenopathies also for lue, particularly in presence of behavioral risk factors.
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Affiliation(s)
- Claudio Cerchione
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy.
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples "Federico II", Italy
| | - Luana Marano
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Novella Pugliese
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Davide Nappi
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Grazia Tosone
- Department of Clinical Medicine and Surgery - Section of Infectious Diseases, University of Naples "Federico II", Italy
| | - Ilaria Cimmino
- Department of Translational Medical Sciences, University of Naples "Federico II", Italy
| | - Imma Cozzolino
- Department of Translational Medical Sciences, University of Naples "Federico II", Italy
| | - Vincenzo Martinelli
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Fabrizio Pane
- Department of Clinical Medicine and Surgery - Hematology, University of Naples "Federico II", Italy
| | - Marco Picardi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Italy
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14
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Tosone G, Mascolo S, Bruni R, Taffon S, Equestre M, Tosti ME, Ciccaglione AR, Martucci F, Liberti A, Iannece MD, Orlando R. A family cluster of hepatitis A virus due to an uncommon IA strain circulating in Campania (southern Italy), not associated with raw shellfish or berries: a wake-up call to implement vaccination against hepatitis A? Infez Med 2016; 24:230-233. [PMID: 27668904] [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: 06/06/2023]
Abstract
Hepatitis A virus is a widely occurring disease, with different prevalence rates between countries in the North and West and those in the South and East. In Italy endemicity is low/medium, but not homogeneously distributed: in the northern/central regions a large hepatitis A outbreak due to genotype IA, related to the consumption of contaminated mixed frozen berries, occurred between 2013 and 2014, whereas in southern Italian regions recurrent outbreaks of hepatitis A, due to the IB genotype, still result from consumption of raw seafood. In 2014 an uncommon genotype IA strain was isolated from five patients (2 adults and 3 children) with hepatitis A, living in the surroundings of Naples (Campania) who did not have any of the most common risk factors for hepatitis A in Italy, such as consumption of raw shellfish or frozen berries, or travel to endemic countries. Moreover, based on the analysis of viral sequences obtained, this strain differed from several others in the national database, which had been recently isolated during Italian outbreaks. This case report reinforces the need to implement both information campaigns about the prevention of hepatitis A and vaccination programmes in childhood; in addition, it would be suitable to sequence strains routinely not only during large outbreaks of hepatitis A in order to obtain a more detailed national database of HAV strains circulating in Italy.
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Affiliation(s)
- Grazia Tosone
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Viral Infection and AIDS Unit, University Federico II, Naples, Italy
| | - Silvia Mascolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Viral Infection and AIDS Unit, University Federico II, Naples, Italy
| | - Roberto Bruni
- Department of Infectious, Parasitic and Immune-mediated Diseases, Viral Hepatitis Section, Istituto Superiore di Sanitá, Rome, Italy
| | - Stefania Taffon
- Department of Infectious, Parasitic and Immune-mediated Diseases, Viral Hepatitis Section, Istituto Superiore di Sanitá, Rome, Italy
| | - Michele Equestre
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanitá, Rome, Italy
| | - Maria Elena Tosti
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanitá, Rome, Italy
| | - Anna Rita Ciccaglione
- Department of Infectious, Parasitic and Immune-mediated Diseases, Viral Hepatitis Section, Istituto Superiore di Sanitá, Rome, Italy
| | - Fiorella Martucci
- Unit of Infectious Diseases, Azienda Ospedaliera dei Colli - Cotugno, Naples, Italy
| | - Alfonso Liberti
- Unit of Infectious Diseases, Azienda Ospedaliera dei Colli - Cotugno, Naples, Italy
| | - Maria Donata Iannece
- Unit of Infectious Diseases, Azienda Ospedaliera dei Colli - Cotugno, Naples, Italy
| | - Raffaele Orlando
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, Viral Infection and AIDS Unit, University Federico II, Naples, Italy
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15
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Spera AM, Eldin TK, Tosone G, Orlando R. Antiviral therapy for hepatitis C: Has anything changed for pregnant/lactating women? World J Hepatol 2016; 8:557-565. [PMID: 27134703 PMCID: PMC4840161 DOI: 10.4254/wjh.v8.i12.557] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/09/2016] [Accepted: 03/23/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) affects about 3% of the world’s population, with the highest prevalence in individuals under 40. The prevalence in pregnant women varies with geographical distribution (highest in developing countries). Prevalence also increases in sub-populations of women at high risk for blood-transmitted infections. HCV infection in pregnancy represents a non-negligible problem. However, most of the past antiviral regimens cannot be routinely offered to pregnant or breastfeeding women because of their side effects. We briefly reviewed the issue of treatment of HCV infection in pregnant/breastfeeding women focusing on the effects of the new direct-acting antivirals on fertility, pregnancy and lactation in animal studies and on the potential risk for humans based on the pharmacokinetic properties of each drug. Currently, all new therapy regimens are contraindicated in this setting because of lack of sufficient safety information and adequate measures of contraception are still routinely recommended for female patients of childbearing potential.
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16
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Maraolo AE, Minervini F, Tosone G. Letter: the potential success of long-term therapy of chronic delta hepatitis with peginterferon alfa. Aliment Pharmacol Ther 2015; 41:595. [PMID: 25659214 DOI: 10.1111/apt.13071] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 12/16/2014] [Indexed: 12/08/2022]
Affiliation(s)
- A E Maraolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II" - Infectious Diseases, Naples, Campania, Italy.
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17
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Orlando R, Foggia M, Maraolo AE, Mascolo S, Palmiero G, Tambaro O, Tosone G. Prevention of hepatitis B virus infection: from the past to the future. Eur J Clin Microbiol Infect Dis 2015; 34:1059-70. [PMID: 25678010 DOI: 10.1007/s10096-015-2341-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 01/27/2015] [Indexed: 12/17/2022]
Abstract
About 3-5 % of the world's population is chronically infected by hepatitis B virus (HBV) and is at risk of developing liver cirrhosis or hepatocellular carcinoma. The risk of dying prematurely because of chronic HBV infection is higher in younger people. The current strategies to prevent HBV infection involve immunization (active and/or passive) and antiviral chemoprophylaxis. The vaccines available for active immunization, containing hepatitis B surface antigen, are safe and confer long-term immunity in most healthy subjects. Since the vaccination is unsatisfactory in some patients, e.g., those with chronic kidney disease, human immunodeficiency virus infection, type I diabetes mellitus, and celiac disease, new strategies of vaccination are required. The neonatal, infant, and adolescent routine program vaccination in about 180 countries has greatly decreased the disease burden. Passive immunization with specific HBV immunoglobulins is recommended after single acute exposure, in infants born to infected mothers, and in HBV-infected patients undergoing liver transplantation combined with nucleoside/nucleotide analogues (chemoprophylaxis). Chemoprophylaxis is also indicated in HBV carrier candidates for immunosuppressive treatment and in patients with occult B infection undergoing immunosuppressive therapy or hematopoietic stem cell transplantation. Since HBV is not eradicable by an immune response or by antiviral drugs developed so far, the only preventive strategy remains global neonatal vaccination in all countries, firstly in HBV-endemic countries.
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Affiliation(s)
- R Orlando
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Via Sergio Pansini 5, 80131, Napoli, Italy
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18
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Tosone G, Maraolo AE, Mascolo S, Palmiero G, Tambaro O, Orlando R. Vertical hepatitis C virus transmission: Main questions and answers. World J Hepatol 2014; 6:538-548. [PMID: 25232447 PMCID: PMC4163737 DOI: 10.4254/wjh.v6.i8.538] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/07/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) affects about 3% of the world’s population and peaks in subjects aged over 40 years. Its prevalence in pregnant women is low (1%-2%) in most western countries but drastically increases in women in developing countries or with high risk behaviors for blood-transmitted infections. Here we review clinical, prognostic and therapeutic aspects of HCV infection in pregnant women and their offspring infected through vertical transmission. Pregnancy-related immune weakness does not seem to affect the course of acute hepatitis C but can affect the progression of chronic hepatitis C. In fact, postpartum immune restoration can exacerbate hepatic inflammation, thereby worsening the liver disease, particularly in patients with liver cirrhosis. HCV infection increases the risk of gestational diabetes in patients with excessive weight gain, premature rupture of membrane and caesarean delivery. Only 3%-5% of infants born to HCV-positive mothers have been infected by intrauterine or perinatal transmission. Maternal viral load, human immunodeficiency virus coinfection, prolonged rupture of membranes, fetal exposure to maternal infected blood consequent to vaginal or perineal lacerations and invasive monitoring of fetus increase the risk of viral transmission. Cesarean delivery and breastfeeding increases the transmission risk in HCV/human immunodeficiency virus coinfected women. The consensus is not to offer antiviral therapy to HCV-infected pregnant women because it is based on ribavirin (pregnancy category X) because of its embryocidal and teratogenic effects in animal species. In vertically infected children, chronic C hepatitis is often associated with minimal or mild liver disease and progression to liver cirrhosis and hepatocarcinoma is lower than in adults. Infected children may be treated after the second year of life, given the adverse effects of current antiviral agents.
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19
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Izzo F, Piccirillo M, Albino V, Palaia R, Belli A, Granata V, Setola S, Fusco R, Petrillo A, Orlando R, Tosone G, Scordino F, Curley SA. Prospective screening increases the detection of potentially curable hepatocellular carcinoma: results in 8,900 high-risk patients. HPB (Oxford) 2013; 15:985-90. [PMID: 23607636 PMCID: PMC3843617 DOI: 10.1111/hpb.12080] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 01/21/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Historically, only 10% of patients with hepatocellular carcinoma (HCC) are diagnosed with early-stage, potentially curable disease. In this study, chronic hepatitis virus-infected patients were prospectively screened to determine: (i) the proportion of patients diagnosed with potentially curable HCC, and (ii) survival following curative therapy. METHODS The study included 8900 chronic hepatitis virus-infected patients enrolled in a prospective screening programme, of whom 1335 (15.0%) were infected with hepatitis B virus (HBV), 7120 (80.0%) with hepatitis C virus (HCV), and 445 (5.0%) with both HBV and HCV. Screening was conducted every 6 months and included serum alpha-fetoprotein (AFP) measurement and ultrasonography. Curative treatments included liver transplantation, resection, radiofrequency ablation and/or ethanol injection. RESULTS Hepatocellular carcinoma was diagnosed in 765 (8.6%) patients. Of 1602 patients with cirrhosis, 758 (47.3%) developed HCC. Curative treatment was possible in 523 (68.4%) of the 765 HCC patients. Two- and 5-year rates of overall survival in the curative treatment group were 65% and 28%, respectively, compared with 10% and 0% in the advanced disease group (P < 0.001). CONCLUSIONS Prospective screening of patients at high risk for the development of HCC increases the proportion of patients diagnosed with potentially curable disease. This may result in an increase in the number of longterm survivors. Screening strategies should focus on patients with chronic HBV or HCV infection who have progressed to cirrhosis because more than 40% of these patients will develop HCC.
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Affiliation(s)
- Francesco Izzo
- Division of Surgical Oncology, G. Pascale National Cancer InstituteNaples, Italy
| | - Mauro Piccirillo
- Division of Surgical Oncology, G. Pascale National Cancer InstituteNaples, Italy
| | - Vittorio Albino
- Division of Surgical Oncology, G. Pascale National Cancer InstituteNaples, Italy
| | - Raffaele Palaia
- Division of Surgical Oncology, G. Pascale National Cancer InstituteNaples, Italy
| | - Andrea Belli
- Division of Surgical Oncology, G. Pascale National Cancer InstituteNaples, Italy
| | - Vincenza Granata
- Department of Radiology, G. Pascale National Cancer InstituteNaples, Italy
| | - Sergio Setola
- Department of Radiology, G. Pascale National Cancer InstituteNaples, Italy
| | - Roberta Fusco
- Department of Radiology, G. Pascale National Cancer InstituteNaples, Italy
| | - Antonella Petrillo
- Department of Radiology, G. Pascale National Cancer InstituteNaples, Italy
| | - Raffaele Orlando
- Department of Infectious Disease, University of Naples Federico IINaples, Italy
| | - Grazia Tosone
- Department of Infectious Disease, University of Naples Federico IINaples, Italy
| | - Fabrizio Scordino
- Department of Infectious Disease, University of Naples Federico IINaples, Italy
| | - Steven A Curley
- Department of Surgical Oncology, University of Texas MD Anderson Cancer CenterHouston, TX, USA
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Veropalumbo E, Marrone A, Vallefuoco L, Perruolo G, Orlando R, Scordino F, Tosone G, Zampino R, Trani B, Genovese A, Spadaro G, D’Orio C, Portella G. Immunocompromised Patients with HBsAgaDeterminant Mutants: Comparison of HBsAg Diagnostic Assays. Intervirology 2010; 53:183-7. [DOI: 10.1159/000289342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Accepted: 12/22/2009] [Indexed: 11/19/2022] Open
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21
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Tiseo D, Tosone G, Conte MCD, Scordino F, Mansueto G, Mesolella M, Parrella G, Pennone R, Orlando R. Isolated laryngeal leishmaniasis in an immunocompetent patient: a case report. Infez Med 2008; 16:233-235. [PMID: 19155691] [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: 05/27/2023]
Abstract
Visceral leishmaniasis, a protozoan disease caused by Leishmania infantum, is endemic in the Mediterranean basin, especially southern and Tyrrhenian Italy. Its aetiological agent can also sporadically cause isolated laryngeal localization in at-risk patients (i.e., heavy smokers, immunocompromised patients). This rare localization is often pauci-symptomatic and thus can easily escape diagnosis. A case of isolated leishmaniasis limited to the left vocal cord in an immunocompetent Italian male without significant risk factors, randomly discovered upon histological examination, is described herein. We inquire how many patients affected by non-specific symptoms such as dysphonia and live in countries where Leishmania infantum infection is reported, could be truly affected by Leishmania spp infection.
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Affiliation(s)
- D Tiseo
- Dipartimento di Medicina Pubblica e Sicurezza Sociale, Sezione di Malattie Infettive, University of Naples Federico II, Naples, Italy
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22
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Tosone G, Tiseo D, Parrella G, Piazza M, Orlando R. Mediastinal teratocarcinoma as initial manifestation of asymptomatic HIV infection: a case report. Minerva Med 2008; 99:417-419. [PMID: 18663349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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23
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Orlando R, Tosone G, Portella G, Veropalumbo E, D'Onofrio M, Piazza M. Prolonged persistence of lamivudine-resistant mutant and emergence of new lamivudine-resistant mutants two years after lamivudine withdrawal in HBsAg-positive chronic hepatitis patient: a case report. Infection 2007; 36:472-4. [PMID: 17962902 DOI: 10.1007/s15010-007-7073-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Accepted: 04/25/2007] [Indexed: 11/24/2022]
Abstract
Lamivudine can select resistant hepatitis B virus (HBV) tyrosine-methionine-aspartate-aspartate aminoacid motif (YMDD) mutants, which usually disappear in few months after lamivudine withdrawal. We report an unusual case of a male adult patient who showed a prolonged persistence of the M204I mutation up to 24 months after lamivudine withdrawal followed by the emergence of new distinct YMDD mutants (namely M204V, V207L). Only 42 months after lamivudine withdrawal wild-type YMDD motif became dominant over the YMDD mutants. To our knowledge, a so prolonged persistence of a YMDD mutant and also the emergence of new YMDD mutants many months after drug withdrawal are unusual.
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Affiliation(s)
- R Orlando
- Department of Public Medicine and Social Security, Section of Infectious Diseases, University of Naples Federico II, Via Sergio Pansini 5, Naples, Italy.
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Tosone G, Borgia G, Gentile I, Cerini R, Conte MCD, Orlando R, Piazza M. A case of pegylated interferon alpha-related diabetic ketoacidosis: can this complication be avoided? Acta Diabetol 2007; 44:167-9. [PMID: 17721757 DOI: 10.1007/s00592-007-0259-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 03/19/2007] [Indexed: 02/08/2023]
Abstract
We report the case of a 42-year-old woman with chronic hepatitis C (genotype 1), who in June 2004 started therapy with pegylated interferon alpha (PEG-IFNalpha) plus ribavirin. Two months later, she discontinued treatment because of polydipsia, polyuria and vomiting leading to a marked dehydration. Biochemical data showed type 1 diabetes mellitus with ketoacidosis, and insulin therapy was started. The patient, who before starting PEG-IFN alpha plus ribavirin therapy tested negative for glutamic acid decarboxylase antibodies (GADAb) and islet cell (ICAb) antibodies, became strongly positive for both autoimmune markers. This case confirms that patients with chronic hepatitis C who do not have baseline markers of pancreatic autoimmunity may develop severe ketoacidosis during treatment with PEG-IFNalpha, as well as with standard IFNalpha. In order to avoid this complication, as no guidelines are available and the pancreatic autoimmunity markers are not routinely analysed, we suggest frequent monitoring (e.g., every one to two weeks) of glycaemic values: e.g., every one to two weeks during the first 3 months (when this complication occurs most frequently) and monthly thereafter so as to identify diabetes at an early stage and before the onset of the appearance of severe ketoacidosis, which is life-threatening.
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Affiliation(s)
- G Tosone
- Department of Public Medicine and Social Security Section of Infectious Diseases, University of Naples Federico II, Via Sergio Pansini 5, I-80131, Naples, Italy.
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25
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Orlando R, Cappabianca P, Tosone G, Esposito F, Piazza M, de Divitiis E. Retrospective analysis of a new antibiotic chemoprophylaxis regimen in 170 patients undergoing endoscopic endonasal transsphenoidal surgery. ACTA ACUST UNITED AC 2007; 68:145-8; discussion 148. [PMID: 17537487 DOI: 10.1016/j.surneu.2006.10.063] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 10/24/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the rate of infectious complications post endoscopic transspheinodal neurosurgery in patients receiving a new antibiotic chemoprophylaxis regimen. METHODS Clinical records of 170 patients who received prophylaxis with a third-generation cephalosporin plus aminoglycoside (160 cases) or alone (10 cases) were retrospectively analyzed. Twenty-eight patients (16.4%) had CSF leakage. The postsurgical follow-up ranged from 3 months to 4 years. RESULTS Of 170 patients, 2 (1.17%) developed infectious complications: 1 case of meningitis by Staphylococcus epidermidis and 1 case of sphenoid sinusitis (without microbiological diagnosis). In addition, asymptomatic sphenoid sinusitis was diagnosed in 2 other patients. The cost ranged from 22.50 to 33.34 euros/d. CONCLUSIONS The rate of infectious complications was very low in patients receiving prophylaxis with a third-generation cephalosporin plus aminoglycoside or alone; because of the broad-spectrum of antibiotics and their high cost, this regimen could be used in at-risk patients (eg, smokers, patients with cerebrospinal leak, or patients with Cushing diseases).
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Affiliation(s)
- Raffaele Orlando
- Department of Public Medicine and Social Security, Section of Infectious Diseases, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131, Napoli, Italy.
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26
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Orlando R, Tosone G, Tiseo D, Piazza M, Portella G, Ciancia R, Martinelli V, Montante B, Rotoli B. Severe reactivation of hepatitis B virus infection in a patient with hairy cell leukemia: Should lamivudine prophylaxis be recommended to HBsAg-negative, anti-HBc-positive patients? Infection 2007; 34:282-4. [PMID: 17033754 DOI: 10.1007/s15010-006-4150-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2004] [Accepted: 01/11/2006] [Indexed: 11/26/2022]
Abstract
The reverse seroconversion to hepatitis B virus infection has been sporadically described in onco-haematological patients receiving cytotoxic therapy or allogeneic bone marrow transplantation and can be associated with the development of acute icteric hepatitis. We present a male HBsAg-negative, anti-HBc-positive patient with Hairy Cell Leukemia who developed acute B hepatitis more than 1 year after the last course of 2-CdA and 6 months after splenectomy, while the patient was receiving therapy with alphaIFNr. The acute B hepatitis promptly responded to lamivudine therapy followed by viral clearance.
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Affiliation(s)
- R Orlando
- Dept. of Public Medicine and Social Security, Section of Infectious Diseases, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
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Oliviero U, Scordino F, Scherillo G, Tosone G, Orlando R, Fazio S. Myocardial ischemia caused by an hydatid cyst of the interventricular septum successfully treated with albendazole. Ital Heart J 2000; 1:431-4. [PMID: 10929745] [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: 02/17/2023]
Abstract
We report the case of a 33-year-old patient with clinical history of echinococcosis admitted to our Hospital for the appearance of chest pain and electrocardiographic findings of anterior ischemia. The cardiac enzymogram was in the normal range, the chest roentgengram did not show any pathological findings, but two-dimensional echocardiography revealed the presence of a small circular area in the interventricular septum. Transesophageal echocardiography and cardiac nuclear magnetic resonance confirmed the presence of a small hydatid cyst in the middle ventricular septum; in addition, a myocardial scintigraphy revealed an apical stress defect with late reperfusion. Besides cardiologic therapy, the patient was treated with albendazole, an antiparasitic drug, 400 mg bid, for cycles of 28 days with 14 day withdrawal. After two cycles of albendazole therapy, two-dimensional echocardiography showed the absence of the round cystic mass of the interventricular septum previously described. In conclusion, in the case described, long-term therapy with albendazole determined the complete recovery from the illness with the simultaneous disappearance of the cyst and of clinical and electrocardiographic findings of myocardial ischemia.
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Affiliation(s)
- U Oliviero
- Department of Clinical Medicine and Cardiovascular Sciences, Federico II University of Naples, Italy.
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Piazza M, Safary A, Vegnente A, Soncini R, Pensati P, Sardo M, Orlando R, Tosone G, Picciotto L. Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination programme. Vaccine 1999; 17:585-8. [PMID: 10075165 DOI: 10.1016/s0264-410x(98)00237-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Forty-eight infants received a single dose (720 ELISA units = 0.5 ml) of inactivated hepatitis A vaccine at the fifth month of age with booster at the 11th month of age, together with the second and third doses of the vaccines compulsory under Italian law (diphtheria, tetanus, oral polio and hepatitis B). Overall, the seroconversion rate was 100%. The anti-HAV geometric mean titre (GMT) reached 3,021 mIU/ml in infants born to anti-HAV-negative mothers, but only 399 mIU/ml in infants born to anti-HAV-positive mothers. Hepatitis A vaccine was immunogenic, safe and well tolerated without significant side-effects. There seems to be no reason for not including it in childhood vaccination programmes particularly in low endemic HAV areas.
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Affiliation(s)
- M Piazza
- Dipartimento di Malattie Infettive, Facoltà di Medicina, Università Federico II di Napoli, Naples, Italy.
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Piazza M, Sagliocca L, Tosone G, Guadagnino V, Stazi MA, Orlando R, Borgia G, Rosa D, Abrignani S, Palumbo F, Manzin A, Clementi M. Prophylaxis of Hepatitis C with Intramuscular Immunoglobulin. BioDrugs 1999; 12:291-300. [DOI: 10.2165/00063030-199912040-00006] [Citation(s) in RCA: 2] [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: 11/03/2022]
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Piazza M, Sagliocca L, Tosone G, Guadagnino V, Stazi MA, Orlando R, Borgia G, Rosa D, Abrignani S, Palumbo F, Manzin A, Clementi M. Sexual transmission of hepatitis C virus and prevention with intramuscular immunoglobulin. AIDS Patient Care STDS 1998; 12:611-8. [PMID: 15468432 DOI: 10.1089/apc.1998.12.611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The sexual transmission of hepatitis C virus (HCV) has long been debated. The prevalence of infected at-risk partners varies from 0% to 30%. In a prospective study, the risk of infection was quantified in steady heterosexual partners and the prophylactic effect of normal human polyvalent immune serum globulin (ISG) was evaluated. A total of 899 at-risk partners of HCV-infected patients were enrolled in a single-blind randomized controlled trial and assigned to receive every 2 month 4 mL of intramuscular ISG from unscreened donors (450 partners) or placebo (499 partners). Seven partners developed acute HCV infection (increased aminotransferase levels and appearance of HCV-RNA): six of the placebo group (incidence density [ID] 12.00/1,000 person year; 95% confidence interval [CI] 3.0 to 21.61), and only one of the ISG-treated group (ID 1.98/1,000 person year; 95% CI 0 to 5.86). The risk of infection was significantly higher in controls versus treated individuals (p = 0.03). Six couples had genotype 1b (85%), and one couple had genotype 1a; HCV sequence homology strongly supported sexual transmission. Our trial demonstrates that HCV infection can be sexually transmitted and quantifies the risk of sexual transmission: for every year of at-risk sexual relationship, almost 1% of the partners became infected. Intramuscular ISG is safe and well tolerated. Unlike ISG from screened donors, ISG from donors unscreened for anti-HCV contains high titers of anti-gpE1/gpE2 neutralizing antibodies and high neutralizing activity. Anti-HCV hyperimmune globulin could be prepared from anti-HCV-positive blood units and could be used to protect sexual partners and in other at-risk situations of exposure to HCV infection.
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Affiliation(s)
- M Piazza
- Institute of Infectious Diseases, Medical School, University "Federico II," Naples, Italy
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31
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Manzin A, Solforosi L, Petrelli E, Macarri G, Tosone G, Piazza M, Clementi M. Evolution of hypervariable region 1 of hepatitis C virus in primary infection. J Virol 1998; 72:6271-6. [PMID: 9621104 PMCID: PMC110460 DOI: 10.1128/jvi.72.7.6271-6276.1998] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.5] [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: 02/07/2023] Open
Abstract
The hypervariable region 1 (HVR-1) of the putative envelope encoding E2 region of hepatitis C virus (HCV) RNA was analyzed in sequential samples from three patients with acute type C hepatitis infected from different sources to address (i) the dynamics of intrahost HCV variability during the primary infection and (ii) the role of host selective pressure in driving viral genetic evolution. HVR-1 sequences from 20 clones per each point in time were analyzed after amplification, cloning, and purification of plasmid DNA from single colonies of transformed cells. The intrasample evolutionary analysis (nonsynonymous mutations per nonsynonymous site [Ka], synonymous mutations per synonymous site [Ks], Ka/Ks ratio, and genetic distances [gd]) documented low gd in early samples (ranging from 2. 11 to 7.79%) and a further decrease after seroconversion (from 0 to 4.80%), suggesting that primary HCV infection is an oligoclonal event, and found different levels and dynamics of host pressure in the three cases. The intersample analysis (pairwise comparisons of intrapatient sequences; rKa, rKs, rKa/rKs ratio, and gd) confirmed the individual features of HCV genetic evolution in the three subjects and pointed to the relative contribution of either neutral evolution or selective forces in driving viral variability, documenting that adaptation of HCV for persistence in vivo follows different routes, probably representing the molecular counterpart of the viral fitness for individual environments.
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Affiliation(s)
- A Manzin
- Istituto di Microbiologia, Università di Ancona, Ancona, Italy.
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32
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Piazza M, Tosone G, Borgia G, Orlando R, Fenzi G, Vitale M, Bloise A, Mariano A, Macchia V. Long-term interferon-alpha therapy does not affect sex hormones in males with chronic hepatitis C. J Interferon Cytokine Res 1997; 17:525-9. [PMID: 9335429 DOI: 10.1089/jir.1997.17.525] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The effects of interferon-alpha (IFN-alpha), given at a dosage of 6 MU thrice weekly for 12 months, on gonadal function were investigated in 18 males affected by chronic hepatitis C. Periodically, all patients were clinically monitored and questioned about sexual function. Gonadotropin and serum androgen concentrations (follicle-stimulating hormone, luteinizing hormone, total testosterone, free testosterone, androstenedione, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and sex hormone binding globulin) were tested every 3 months. Ten of 18 patients (55%) responded to IFN-alpha therapy. Serum total testosterone and sex hormone binding globulin values decreased slightly at the third month of treatment, then returned to baseline values. Serum free testosterone and other sex hormones remained essentially unchanged during IFN-alpha therapy. Four patients (22.2%) complained of sexual dysfunction (impaired libido, erectile failure, and impaired ejaculation), which was unrelated to any significant hormonal change and resolved after IFN therapy was stopped. Serum sex hormones values did not differ between responders and nonresponders to IFN-alpha. This study indicates that 12 months treatment with 6 MU of IFN-alpha thrice weekly does not significantly affect gonadal function in men with chronic hepatitis C. The sexual dysfunction observed could be ascribed to such other side effects of IFN as asthenia, fatigue, or anxiety, or it could have a psychologic basis.
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Affiliation(s)
- M Piazza
- Instituto Malattie Infettive, Università degli studi di Napoli Federico II, Naples, Italy
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33
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Piazza M, Sagliocca L, Tosone G, Guadagnino V, Stazi MA, Orlando R, Borgia G, Rosa D, Abrignani S, Palumbo F, Manzin A, Clementi M. Sexual transmission of the hepatitis C virus and efficacy of prophylaxis with intramuscular immune serum globulin. A randomized controlled trial. ACTA ACUST UNITED AC 1997. [PMID: 9236555 DOI: 10.1001/archinte.1997.00440350037004] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To estimate the risk of sexual transmission of hepatitis C and to assess the value of prophylaxis with periodic intramuscular immune serum globulin administration. METHODS Of 1102 steady heterosexual partners of patients with antibodies to the hepatitis C virus (HCV), 899 were enrolled in a single-blind, randomized, controlled trial. All the partners tested negative for antibodies to HCV and had normal baseline serum aminotransferase concentrations. The partners were assigned to receive 4 mL of 16% polyvalent immune serum globulin prepared from unscreened donors every 2 months (n = 450) or a placebo (n = 449). Tests for HCV infection were performed every 4 months. RESULTS Eight hundred eighty-four partners completed the study. Seven partners became infected with HCV: 6 in the control group (incidence density, 12.00 per 1000 person-years; 95% confidence interval, 3.0 21.61) and 1 in the immune serum globulin group (incidence density, 1.98 per 1000 person-years; 95% confidence interval, 0-5.86). The risk of infection was significantly higher for partners in the control group (P = .03): for each year approximately 1% of the partners became infected. Sequence homology studies strongly suggest the sexual transmission of HCV. All immune serum globulin lots used had high enzyme-linked immunosorbent assay titers of neutralizing antibodies to HCV envelope glycoproteins and high neutralization titers in the neutralization of binding assay. CONCLUSIONS Hepatitis C can be sexually transmitted. Immune serum globulin prepared from unscreened donors significantly reduced the risk. The treatment was safe and well tolerated. Because only immune serum globulin from unscreened donors (and not from those screened for HCV) contain anti-HCV neutralizing antibodies, hyperimmune anti-HCV immune serum globulin should be prepared from blood testing positive for antibodies to HCV, which is currently discarded.
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Affiliation(s)
- M Piazza
- Istituto di Malattie Infettive, Universitá degli Studi di Napoli Federico II, Naples, Italy
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Orlando R, Tosone G, Nappa S, Piazza M. Re: S. Iwarson: new vaccines against hepatitis A enter the market--but who should be vaccinated? (Infection 20 [1992] 192-193). Infection 1993; 21:131. [PMID: 8387964 DOI: 10.1007/bf01710751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Abstract
In a study of 87 patients with chronic hepatitis C, 12 months' treatment with interferon alfa-2b at a dose of 6 million units (MU) three times per week seemed to be more effective than treatment with 3 MU three times a week for two months plus 1.5 MU three times a week for 10 months in increasing the percentage of long term responders. The percentage of patients in whom alanine amino-transferase activities returned to normal was highest in the 6 MU group, as was the percentage of responders who sustained this normal activity after treatment. Side effects were moderate and self-limited in most patients.
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Affiliation(s)
- M Piazza
- Department of Infectious Diseases, II Medical School, University of Naples, Italy
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36
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Orlando R, Tiseo D, Tosone G, Cangiano F. [Malaria epidemiology]. Recenti Prog Med 1990; 81:778-81. [PMID: 2075279] [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: 12/30/2022]
Abstract
The investigators examine the worldwide epidemiological aspects of malaria infection, stressing the importance of possible alternative pathways of Plasmodium transmission in countries considered free of infection. The potential danger due to the persistence in Italy of the Anopheles mosquito, which could resume its role as a vector of Plasmodium in the future, is pointed out.
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Affiliation(s)
- R Orlando
- Clinica delle Malattie infettive, II Facoltà di Medicina e Chirurgia, Università, Napoli
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Tiseo D, Orlando R, Tosone G, Cangiano F, Paone G. [Malaria prevention: new indications]. Recenti Prog Med 1990; 81:754-8. [PMID: 2075275] [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: 12/30/2022]
Abstract
Malaria chemoprophylaxis must be continuously modified because of drug-resistant Plasmodium strains. The authors report the most recent regimens in all travelers including infants and pregnant women. The side effects of these drugs are pointed out.
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Affiliation(s)
- D Tiseo
- Clinica delle Malattie infettive, II Facoltà di Medicina e Chirurgia, Università, Napoli
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38
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Tosone G, Orlando R, Tiseo D, Cangiano F. [An update on the therapy of malaria]. Recenti Prog Med 1990; 81:759-63. [PMID: 2075276] [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: 12/30/2022]
Abstract
The authors analyze the recent treatment regimens of malaria, related to Plasmodium strains and clinical manifestation. Chloroquine is the first choice drug for uncomplicated chloroquine-sensitive P. falciparum, whereas for P. malariae, P. vivax and P. ovale infections treatment with chloroquine plus primaquine is also recommended. For uncomplicated chloroquine-resistant P. falciparum infections many treatment regimens are available. Management of complications is also analyzed.
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Affiliation(s)
- G Tosone
- Clinica delle Malattie infettive, II Facoltà di Medicina e Chirurgia, Università, Napoli
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39
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Orlando R, Tiseo D, Tosone G, Cangiano F, Scordino F. [Antimalarial chemoprophylaxis in pregnancy]. Minerva Ginecol 1990; 42:45-7. [PMID: 2187165] [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: 12/30/2022]
Abstract
The drugs available for malaria chemoprophylaxis in pregnancy and their posology, side-effect in pregnant women and foetus are analyzed particularly for areas of high multidrug resistance. Chloroquine and proguanil are the most used with few side-effects, while pyrimethamine is recommended only for chloroquine-resistant Plasmodium falciparum spp.
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Affiliation(s)
- R Orlando
- Clinica delle Malattie Infettive, II Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli
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Del Pezzo M, De Filippis A, D'Alessio A, Rosiello M, Tosone G, Gulletta E. A serological study of mycobacterial infections in AIDS and HIV-1 positive patients. G Batteriol Virol Immunol 1990; 83:3-9. [PMID: 2133326] [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: 12/30/2022]
Abstract
The Authors have tested the new Tb-Elisa method to detect specific antibodies, raised against A60 major mycobacterial antigen complex, in patients of groups II, III and IV of CDC classification suffering from acquired immunodeficiency and in HIV-1 negative control subjects. The test results support laboratory diagnosis of acute phase and reactivation of mycobacterial infection.
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Affiliation(s)
- M Del Pezzo
- Dipartimento di Biologia e Patologia Cellulare e Molecolare, II Facoltà di Medicina, Università degli Studi, Napoli
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Orlando R, Tiseo D, Tosone G, Cangiano F, Scordino F. [Antimalarial chemoprophylaxis in children]. Minerva Pediatr 1989; 41:577-9. [PMID: 2699513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In early age, drugs without side effects are required for malaria chemoprophylaxis. Several regimens are available for drug-resistant plasmodium spp in many countries.
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Orlando R, Tosone G, Del Pezzo M, Piccoli S, Rendano F, Palimento D, Conti A. [An indirect hemagglutination study of total IgE and complement fractions C3c and C4 in patients with hepatic hydatidosis and undergoing therapy]. Minerva Med 1989; 80:1289-92. [PMID: 2622570] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The trend of antibodies tested with indirect hemagglutination, of total IgE and complement fraction was examined in patients with liver hydatid disease, treated with surgery and benzoimidazoles.
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Affiliation(s)
- R Orlando
- II Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli
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Tiseo D, Orlando R, Tosone G, Cangiano F, Scordino F. [Antimalarial chemoprophylaxis. Recent advances]. Recenti Prog Med 1988; 79:509-12. [PMID: 3241903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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44
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Orlando R, Tosone G, Tiseo D, Del Pezzo M, Piccoli S, Rendano F, Palimento D. [Hepatic hydatidosis in Campania. Preliminary data on its spread and risk factors]. Recenti Prog Med 1988; 79:452-4. [PMID: 3231890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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45
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Orlando R, Tosone G, De Fino M, Cangiano F. [Changes in the levels of serum zinc in chronic hepatopathy]. Minerva Med 1987; 78:1759-63. [PMID: 3696451] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Serum zinc levels were investigated in patients with chronic liver diseases and in control subjects. The results shows that serum zinc was significantly decreased in patients with chronic liver diseases, in contrast to controls. Zinc deficiency seems to be related to hepatic injury and not to alcoholic intake.
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Affiliation(s)
- R Orlando
- II Facoltà di Medicina e Chirurgia, Università degli Studi di Napoli
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Guadagnino V, Chirianni A, Picciotto L, Borgia G, Cangiano F, Tosone G, Manzillo E, Acampora A, Piazza M. [Effect of cocaine administration on experimental hepatitis in the mouse caused by MHV-3 virus: preliminary results]. Boll Soc Ital Biol Sper 1986; 62:1401-8. [PMID: 3030376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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