Hepatitis B and immigrants: a SIMIT multicenter cross-sectional study

BACKGROUND

The continuing migration of individuals from geographic areas with high/medium endemicity has determined the arrival of new chronic hepatitis B virus (HBV) carriers in Italy. The magnitude of this phenomenon and clinical/virological features of HBsAg-positive migrants remain not very well defined.

AIMS

To evaluate the proportion of HBsAg-positive immigrants enrolled in this multicenter Società Italiana di Malattie Infettive e Tropicali (SIMIT) cross-sectional study and to compare the characteristics of chronic hepatitis B infection in migrants to those of Italian carriers.

METHODS

From February 1 to July 31 2008, anonymous data were obtained from all HBsAg-positive patients aged ≥ 18 years observed at 74 Italian centers of infectious diseases.

RESULTS

Of the 3,760 HBsAg-positive subjects enrolled, 932 (24.8 %) were immigrants, with a prevalent distribution in central to northern Italy. The areas of origin were: Far East (37.1 %), Eastern Europe (35.4 %), Sub-Saharan Africa (17.5 %), North Africa (5.5 %), and 4.5 % from various other sites. Compared to Italian carriers, migrants were significantly younger (median age 34 vs. 52 years), predominantly female (57.5 vs. 31 %), and most often at first observation (incident cases 34.2 vs. 13.3 %). HBeAg-positives were more frequent among migrants (27.5 vs. 14 %). Genotype D, found in 87.8 % of Italian carriers, was present in only 40 % of migrants, who were more frequently inactive HBV carriers, with a lower prevalence of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Only 27.1 % of migrants received antiviral treatment compared to 50.3 % of Italians.

CONCLUSIONS

Twenty-five percent of all HBV carriers examined at Italian centers was composed of immigrants with demographic, serological, and virological characteristics that differed from those of natives and appeared to have an inferior access to treatment.

Hepatitis B and immigrants: a SIMIT multicenter cross-sectional study

BACKGROUND

The continuing migration of individuals from geographic areas with high/medium endemicity has determined the arrival of new chronic hepatitis B virus (HBV) carriers in Italy. The magnitude of this phenomenon and clinical/virological features of HBsAg-positive migrants remain not very well defined.

AIMS

To evaluate the proportion of HBsAg-positive immigrants enrolled in this multicenter Società Italiana di Malattie Infettive e Tropicali (SIMIT) cross-sectional study and to compare the characteristics of chronic hepatitis B infection in migrants to those of Italian carriers.

METHODS

From February 1 to July 31 2008, anonymous data were obtained from all HBsAg-positive patients aged ≥ 18 years observed at 74 Italian centers of infectious diseases.

RESULTS

Of the 3,760 HBsAg-positive subjects enrolled, 932 (24.8 %) were immigrants, with a prevalent distribution in central to northern Italy. The areas of origin were: Far East (37.1 %), Eastern Europe (35.4 %), Sub-Saharan Africa (17.5 %), North Africa (5.5 %), and 4.5 % from various other sites. Compared to Italian carriers, migrants were significantly younger (median age 34 vs. 52 years), predominantly female (57.5 vs. 31 %), and most often at first observation (incident cases 34.2 vs. 13.3 %). HBeAg-positives were more frequent among migrants (27.5 vs. 14 %). Genotype D, found in 87.8 % of Italian carriers, was present in only 40 % of migrants, who were more frequently inactive HBV carriers, with a lower prevalence of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Only 27.1 % of migrants received antiviral treatment compared to 50.3 % of Italians.

CONCLUSIONS

Twenty-five percent of all HBV carriers examined at Italian centers was composed of immigrants with demographic, serological, and virological characteristics that differed from those of natives and appeared to have an inferior access to treatment.

Factors associated with access to antiviral treatment in a multicentre cross-sectional study of patients with chronic hepatitis B in Italy

A multicentre cross-sectional survey was performed to provide an accurate picture of patients with chronic hepatitis B (CHB) cared for by Italian Infectious Diseases Centers (IDCs). This analysis describes factors associated with access to the treatment of CHB in a country where barriers to treatment are not expected to exist because of comprehensive coverage under the National Health System (NHS). The study was performed in 74 IDCs. The analysis focused on 3305 patients with CHB of 3760 HBsAg-positive patients enrolled from March to September, 2008. To account for missing values, a Multiple Imputation method was used. Treatment was reported in 2091 (63.3%) patients. In the multivariate analysis, an increased chance of getting treatment was independently associated with 10 years increase of age at diagnosis (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 1.1-1.3, P < 0.001), HBeAg positivity (aOR 1.8, 95% CI 1.1-2.8, P < 0.001), cirrhosis (aOR 3.6, 95% CI 2-6.3, P = 0.012), HDV (aOR 1.6, 95% CI 1.02-2.5, P = 0.042) and HIV positivity (aOR 6.5, 95% CI 4-10.8, P < 0.001). Conversely, a decreased chance was associated with female gender (aOR 0.6, 95% CI 0.5-0.7, P < 0.001), immigration (aOR 0.6, 95% CI 0.5-0.9, P = 0.009), alcohol consumption (aOR 0.7, 95% CI 0.5-0.98, P = 0.04) and HCV positivity (aOR 0.5, 95% CI 0.3-0.8, P = 0.005). Our study shows that Italian IDCs treat a high percentage of patients with CHB. Nevertheless, disparities exist which are not related to the severity of disease limiting access to antiviral therapy of CHB, even in a country with a universal healthcare system.

[Epidemiology of salmonellosis in Caltagirone area (Sicily)]

The authors report the results of an epidemiological-clinical study concerning episodes of salmonellosis observed in Caltagirone (CT) from 1999 to 2002 and reported to the National Centre for Control of pathogen enterobacteria (enter-net Italy). Overall, two hundred and forty strains of salmonella were isolated, typed and in vitro tested for susceptibility to eleven different antibiotics. Cases were evaluated according to patients' age, risk factors and clinical findings. Salmonella enteritidis (39%) was the most prevalent serovar followed by S. typhimurium (16%), S. newport (6%), S. salamae (5%) and others. The highest rate of antibiotic resistance was observed in S. typhimurium.

[Human and animal brucellosis in Caltagirone (CT) area: epidemiological features]

The Authors report an epidemiological investigation about human and animal brucellosis, during 1993-97, in Caltagirone (CT) area. A remarkable increase of the cases of human brucellosis related to the increase of ovine-caprine brucellosis cases because of particular climatic conditions during 1996 (morbility index 61 x 100.000 residents) is reported. Despite the great endeavour of the Veterinary Service of District, the results of prophilaxis of ovine-caprine brucellosis are modest. Looking forward to the eradication of the animal brucellosis, it is necessary to intervene on the market of the milk and its products to decrease the human brucellosis.

[Sepsis: our series]

Sepsis understood as persistent bacteremia with considerable clinical symptomatology that can develop into septic shock, retains its clinical, diagnostic and therapcutic meaning. Its most recent definition as a systemic inflammatory secondary reaction to a verified infection may help us to understand the reactive events of the host against infections and prevent septic shock. We report clinical cases of sepsis with positive haemoculture observed in the Caltagirone (CT) Hospital in the last 15 years: 186 patients (117 males and 69 females), with particular focus on those over 61 years old and on patients admitted to the ICU. The clinical isolates and groups of the inpatients are listed. In particular, two cases of toxic shock syndrome and six cases of bacterial endocarditis are described. Mortality was about 30% for septic shock despite rational antibiotic therapy, support therapy and hospital admission to the intensive care unit

[Neurobrucellosis: clinical and therapeutic features]

Brucellosis is a common zoonosis endemic in many parts of the world. Neurologic involvement is a rare but serious complication and it occurs in 2 - 5% of cases. Neurologic signs can appear during the active phase of disease or later. Six cases of neurobrucellosis are described: meningoencephalitis in 2 cases, meningitis with brain abscess in 1 case, encephalomielitis in 3 cases. Diagnosis was made on the basis of history of the exposure to brucella, of serum and cerebrospinal fluid positive serology, of quantitative change in cerebrospinal fluid, on EEG, CT and MNR and favorable response to specific treatment (rifampin, rolitetracycline tirmethoprim-sulfamethoxazole). Neurobrucellosis should be suspected in case of neurological deficit in brucellosis endemic areas. Treatment of neurobrucellosis remains controversial: we recommend a regimen with rifampin 600 mg x 2 i.v. + tirmethoprim-sulfamethoxazole 2 ff x 2 i.v. for a period of 6-8 weeks.

[CD30 (ki-1) antigen expression in acute infectious mononucleosis]

The activation antigen CD30 (Ki-1) which is expressed by the lymphocytes T and B is related to the "nerve growth factor" (NFGR) like the receptor of the "tumor necrosis factor" (TNF) and is expressed in the group of large-cell anaplastic lymphoma (ACLC) and Hodgkin's lymphoma and in non-Hodgkin's lymphoma and within the T cells of infectious Mononucleosis. We describe a case of a 18 year-old who contracted Acute Infectious Mononucleosis showing lateral cervical lympho adenopathy. The histologic examination was suggestive for a large-cell anaplastic lymphoma with the antigen CD30, expressed by severa atypical immunoblasts. The remarkable immunoblastic proliferation with Reed-Sternberg-like cells, in milieu polymorphous inflammatory cells present in the course of Infectious Mononucleosis, can simulate large cell anaplastic lymphoma, as well as Hodgkins disease and non-Hodgkins lymphoma. The diagnosis for Infectious Mononucleosis is usually clinical and serological but in cases of cervical lymphnode biopsy a differential diagnosis must be done with positive lymphoma CD30. The criteria to differentiate histologically the Infectious Mononucleosis with large cell anaplastic lymphoma and non-Hodgkin s lymphoma are discussed. Finally, the relationship between Infectious Mononucleosis and lymphoproliferative disease Epstein-Barr virus related is examined.

[Antibiotic resistance monitoring of nosocomial clinical isolates]

The authors evaluate the epidemiological trend of in vitro resistance of 2,196 clinical isolates, chiefly Gram-negative, in Caltagirone hospital in 1998/99 to piperacillin-tazobactam, piperacillin, cefotaxime, ceftazidime, ceftriaxone, imipenem, ciprofloxacin and tobramicin. The resistance percentage is reported for each year in order to study the phenomenon in time. The following results were obtained: resistance frequently increases or rarely stays constant in time for all antibiotics used; the resistance percentage is very high for some strains of bacteria; monitoring of resistance in a hospital can help in choosing the empirical therapy. Piperacillin-tazobactam, imipenem and ciprofloxacin were the most active drugs against clinical isolates.

[Complications of mediterranean spotted fever]

Mediterranean spotted fever is an infectious disease due to Rickettsia conori transmitted to man by the dog tick Rhipicephalus sanguineus. The review of a consecutive series of 525 cases, admitted to Caltagirone hospital in the last 20 years, permits the classic clinical picture to be identified by fever, maculopapular eruption and tache noire, and any complications to be visualized. Usually the course of the disease is good, but 12.7% of our cases reported complications such as renal failure, myocarditis, pneumonia, encephalitis, anicteric hepatitis, gastrointestinal bleeding, anaemia and impaired glucose tolerance. The development of a systemic vasculite is the main pathogenetic factor in the origin of systemic complications. Early diagnosis and specific antibiotic treatment may reduce the risk of complications.

An observational study on the epidemiology of respiratory tract bacterial pathogens and their susceptibility to four injectable beta-lactam antibiotics: piperacillin, piperacillin/tazobactam, ceftazidime and ceftriaxone

Bacterial infections of the respiratory tract account for a large proportion of total medical consultations in general practice. In recent years, antibiotic resistance has increased alarmingly in a number of bacterial species that are common causes of these infections. The aim of this observational study was to determine the antibiotic resistance of microbial agents isolated from patients with acute or acutely exacerbated respiratory infections. Subjects recruited as potential sources of bacteria were either outpatients seen in a number of specialized clinics and hospital practices, or hospitalized patients. Overall, 648 consecutive patients (67% male, mean age 48.1+/-27.0 years) with infection of the upper or lower respiratory tract were observed during a 13-month period. A total of 551 pathogenic microbial strains were isolated and tested for their in vitro susceptibility to piperacillin, piperacillin/tazobactam, ceftazidime, and ceftriaxone. Among all isolates, the four most frequent pathogens were Pseudomonas aeruginosa (132 isolates, 24%), Streptococcus pyogenes (99 isolates, 18%), Staphylococcus aureus (93 isolates, 17%), and Klebsiella pneumoniae (46 isolates, 8%). The susceptibility of gram-positive isolates ranged from 97.5% to 95.1%, and no remarkable difference was found in the antibacterial activity of tested b-lactam antibiotics. The susceptibility of gram-negative isolates to piperacillin and piperacillin/tazobactam was also similar: 96.5% and 97.1%, respectively. In contrast, differences were found between piperacillin (or piperacillin/tazobactam) and either ceftazidime (p=0.003) or ceftriaxone (p<0.0003) in gram-negative isolates. We conclude that, despite the extensive use of beta-lactam antibiotics (piperacillin, ceftazidime, and ceftriaxone) in medical practice during the past three decades, the susceptibility of the most common pathogens involved in the etiology of upper and lower respiratory tract infections to these antibiotics is still high. In particular, bacterial resistance developed by gram-positive organisms against piperacillin is negligible and not alarming.

[Intestinal amoebiasis with hepatic abscess: a case report]

The Authors report an imported case of intestinal amoebiasis with hepatic abscess in a Sicilian young man, living in Venezuela. The clinical aspects (anamnesis about residence in endemic area, abdomen disorders, pain in right hipocondrium, fever, hepatomegaly, slimming), the diagnostic aspects (faeces parasitologic test, bio-humoral and serological tests, ultrasonography, scintigraphy and T.C. of the liver) and therapy (medical and surgical treatment, drainage of abscess cavity) are described. Medical therapy (metronidazole plus chloroquine plus paronomycine) cleared up intestinal infection and reduced hepatic abscess.

[Prevalence of hepatitis C virus infection in different groups of selected populations]

The objective of this study to determine the prevalence of hepatitis C virus at Caltagirone (CT) among blood donors, health care workers, drug users, hemodialysis patients and thalassaemics. The identification of risk factors for HCV infection and liver function in HCV correlate hepatitis. Anti-hepatitis C virus antibodies were detected in 0.64% of blood donors, in 68.44% of drug users, in 58.55% hemodialysis patients and in 67.50% of thalassaemics. Drug abuse, haemodialysis, blood transfusions are the major risk factors for hepatitis C.

[Antibiotic consumption in a general hospital]

The authors evaluated the consumption of injectable antibiotics in a General Hospital during the last two years to analyze the costs trend in order to improve a policy program; they calculated the cost by antibiotic by day of staying and by hospitalization. They pointed out a negative trend for antibiotic expense that can be explained by a more frequent use of short course prophylaxis in Surgery Units, more appropriate therapies in Medical Wards, use of sequential therapy that frequently permits an early discharge.