Combination of conventional blood cultures and the SeptiFast molecular test in patients with suspected sepsis for the identification of bloodstream pathogens

We evaluated performances of the molecular test SeptiFast (SF) for the detection of agents of bloodstream infection (BSI) in patients with suspected sepsis, the majority of them under antibiotic treatment and at high prevalence of HIV-1 infection (10.5%). Matched SF and blood culture (BC) samples (n=1186) from 1024 patients were studied. Two hundred fifty-one episodes of BSI out of 1144 were identified with the combined methods (22%). SF identified more episodes of BSI than BC: 206 versus 176 (χ(2)=7.008, P=0.0081) and a significantly higher number of Gram-negative bacteria than BC (77 versus 53, χ(2)=9.12; P=0.0025), as well as of polymicrobial infections (χ(2)=4.50, P=0.0339). In conclusion, SF combined with BC improved the diagnosis of sepsis, especially in immunocompromised patients.

Two pediatric cases of multidrug-resistant tuberculosis treated with linezolid and moxifloxacin

We report here 2 pediatric cases of multidrug-resistant (MDR) tuberculosis (TB) that were observed in Italy. Both families came from an Eastern European country, which is notably an area with a high prevalence of MDR TB. An increase of new cases of MDR TB in developed countries is expected over the next years because of migratory flow, and specific measures and strategies need to be taken to prevent the propagation and dissemination of MDR TB. An efficacious treatment including linezolid and moxifloxacin was administered for 13 months in 1 case. No adverse reactions were detected during close child monitoring. Linezolid and newer fluoroquinolones such as moxifloxacin have been reported to be effective for MDR-TB treatment in adults. On the contrary, there is limited available evidence regarding the effectiveness and safety of these drugs in infants and children with MDR TB. The use of second-line drugs not approved for use in children may be necessary to treat a life-threatening disease such as MDR TB, but it requires careful monitoring to quickly recognize the occurrence of dose- and duration-dependent adverse drug reactions.

Use of IgG Avidity test in case definitions of toxoplasmosis in pregnancy

A survey network for congenital toxoplasmosis (TOXO-NET) was set up in December 1996 in Piedmont (Italy). Participants were asked to classify the infections in pregnant mothers and newborns by the criteria of the European Network on Congenital Toxoplasmosis published by Lebech in 1996. Because the IgG Avidity test is largely employed as a 2nd level test in toxoplasmosis diagnosis and it could be helpful to date infection, the co-ordinators of TOXO-NET suggested including it in the "case definition" of "probable" infection and "unlikely" infection. 117 cases of toxoplasmosis in pregnancy divided into the risk categories under Lebech's criteria were re-examined using the "new" case definitions. 77 out of 117 (65.8%) Toxoplasma gondii infections during pregnancy could be defined with only one serum sample using the IgG Avidity test. The IgG Avidity test proved a useful method to classify the Toxoplasma gondii infections in pregnancy, especially when we had only one serum sample.

Correlation between germ tube production, phospholipase activity and serotype distribution in Candida albicans

One-hundred and thirteen Candida albicans strains isolated from patients infected by the human immunodeficiency virus (HIV) and twenty five from HIV-negative individuals were studied. The C. albicans strains isolated from different sites of the body were tested for germ-tube (GT), phospholipase production and serotype. The results obtained indicate that the serotype A was predominant in all the groups except for the vaginal strains. No correlation was observed between phospholipase activity and serotype distribution. Germ tube (GT) production was higher among the serotype B strains. A positive correlation between GT induction and phospholipase activity was observed only for the isolates from the oral cavity. It is possible that the correlation between phospholipase activity and high GT production in C. albicans strains can facilitate the penetration through the mucosa.

[Clinical and pharmacokinetic observations on fluconazole in the management of cryptococcal meningitis]

The above study was intended to evaluate certain pharmacokinetic properties as well as the pharmacological activity of fluconazole in patients with cryptococcal meningitis. The results obtained show satisfactory bioavailability of the drug in the cerebrospinal fluid and marked reduction of the number of fungi found in the liquor.

[Hormonal evaluation in the diagnosis of obesity associated with "primary empty sella"]

To determine whether obesity associated with "primary empty sella" (PES) had a characteristic hormonal pattern, we evaluated the hormonal profile in 24 simple obese and 19 obese-PES women. The latter group showed a significant delta-GH and LH impaired levels as well as plasma beta-EP significantly higher. Hence, the beta-EP measurement could be used to predict the hormonal response in these women.

Disability and depression in rheumatoid arthritis. A multi-trait, multi-method investigation

In a sample of 107 patients with classic or definite rheumatoid arthritis (RA), we examined the convergent and divergent validity of measures of disability and depression. Scores on the self-report Disability index of the Health Assessment Questionnaire were highly correlated with physical therapist and spouse ratings of disability. Although Health Assessment Questionnaire disability scores were significantly correlated with self-reported and interviewer-assessed ratings of depression, these correlations were significantly smaller. Factor analyses of the Beck Depression Inventory (BDI) and rheumatologist ratings of BDI items indicated that this measure is highly contaminated by the inclusion of items reflecting RA disease severity. A dysphoric mood subcomponent of the BDI may be a more valid measure of depression in RA populations. Although depression and disability are clearly positively correlated in RA patients, depression scales that include somatic items are likely to yield an overestimate of the association. Finally, self-reported pain intensity was more clearly related to disability and reported recent disease activity than to depression.

[Evaluation of the antibody response and antigenemia in anti-HIV positive subjects with or without candidiasis]

As a diagnostic tool in infectious diseases by CANDIDA species, two different commercial kits have been tested. A LATEX agglutination-test for CANDIDA circulating antigens and an E.L.I.S.A. for detecting specific antibodies. We have examined 107 sets of anti-HIV + subjects (63 with positive culture and 44 negative) against 44 health controls. All controls were negative for circulating antigens, where as 27% resulted positive for specific antibodies. In the group of anti-HIV +, with positive culture for CANDIDA the 45% proved positive for CANDIDA circulating antigens, whereas only the 9.5% resulted negative. The results, shown in the present work, suggests the weight of LATEX test for its diagnostic reliability, its simplicity, while the E.L.I.S.A. for detection of specific antibodies turns out of difficult interpretation in distinguishing between common colonization and infection by CANDIDA species.

[Evaluation of a rapid agglutination method for the identification of Staphylococcus aureus]

It has been valued a new quick latex method (Staphaurex Wellcome) for the identification of the aureus Staphylococcus. This shown simultaneously the Clumping Factor (CF) and the A protein; the production of the free Coagulase (CL) and the Thermonuclease (TNase), has been utilized as methods of remarking. On 120 bacterial stocks isolated by many biological materials, belonging to the family of the Micrococcaceae, 56 stocks was identified as aureus. St. and 64 as not aureus St. For what concerns the quick Staphaurex method, it has shown a sensitivity of 83.4, with 8 false negatives on 120 cases, while it proved very satisfactory as specification with one false positive.

The effects of myofascial trigger point injections are naloxone reversible

Ten patients with myofascial trigger point pain were entered into a double-blind cross-over study of the reversibility of myofascial trigger point injection (TPI) effects with naloxone versus placebo in order to test the hypothesis that the benefits of TPI are mediated, at least in part, through activation of an endogenous opioid system. Injection of trigger points with 0.25% bupivacaine decreased pain in all subjects and increased range of motion in subjects who, on initial assessment, demonstrated limitations of movement of the affected part(s). Allodynia and palpable bands preceding TPI when present also showed reduction after TPI. All improvements afforded by TPI were significantly reversed with intravenous naloxone (10 mg) compared to intravenous placebo. These results demonstrate a naloxone-reversible mechanism in TPI therapy. This suggests an endogenous opioid system as a mediator for the decreased pain and improved physical findings following injection of myofascial trigger points with local anesthetic.

[Discovery of a monoclonal gammopathy in 2 brothers and its classification by electroimmunodiffusion]

In this work the finding of a monoclonal band in two brothers is communicated. The electroimmunoprecipitation has been used for the typification. This technique seemed to be simple, rapid and of immediate interpretation.