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Remelli F, Mattioli I, Govoni B, Zurlo A, De Giorgio R, Volpato S, Cultrera R. Recurrence of Clostridioides difficile infection and mortality in older inpatients. Eur Geriatr Med 2024:10.1007/s41999-024-00942-x. [PMID: 38448711 DOI: 10.1007/s41999-024-00942-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/10/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The prevalence of Clostridioides difficile infection in older and frail population is extremely high and adverse outcomes, including future recurrences and premature mortality, are common. Nonetheless, the clinical risk profile for Clostridioides difficile recurrence in older people is still controversial. We aimed to investigate: 1) the association between Clostridioides difficile recurrence and 6-month mortality; 2) the risk factors for Clostridioides difficile recurrence after hospital discharge. METHODS This is a retrospective study on adults with a first episode of Clostridioides difficile infection admitted to all Internal Medicine and Geriatrics Units of the University Hospital of Ferrara (Italy) between January 2018 and December 2020. For each patient, sociodemographic, clinical and laboratory data were collected through hospital database system. The primary and secondary outcomes were mortality and recurrence within 6 months from the first infectious episode, respectively. RESULTS The mean age of the 386 enrolled patients was 77.8 years; 61.7% were females. Twelve percent patients had Clostridioides difficile recurrence and 32.1% patients died during the 6-month follow-up. At Cox analysis, after adjustment for the potential confounders, participants with recurrence reported a twofold risk of death compared to those without recurrence (HR, 95% CI 2.45, 1.59-3.78). Compared to patients treated with metronidazole, those treated with vancomycin showed a lower risk of recurrence (log-rank p < 0.001). CONCLUSION Clostridioides difficile recurrence is associated with a higher risk of mortality and it may itself be a marker of frailty and vulnerability. Vancomycin treatment during the infectious episode was associated with lower recurrence rate, as compared to metronidazole.
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Affiliation(s)
- Francesca Remelli
- Department of Medical Science, University of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Irene Mattioli
- Department of Medicine, Azienda AUSL of Ferrara, Ferrara, Italy
| | - Benedetta Govoni
- Geriatrics Unit, Azienda Ospedaliero-Universitaria of Ferrara, Ferrara, Italy
| | - Amedeo Zurlo
- Department of Medical Science, University of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy
- Geriatrics Unit, Azienda Ospedaliero-Universitaria of Ferrara, Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Science, University of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy.
- Geriatrics Unit, Azienda Ospedaliero-Universitaria of Ferrara, Ferrara, Italy.
| | - Rosario Cultrera
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Infectious Diseases, Azienda Unità Sanitaria Locale of Ferrara, Ferrara, Italy
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Borghi A, Flacco ME, Pacetti L, Orioni G, Marzola E, Cultrera R, Guerra V, Manfredini R, Gaspari V, Segala D, Corazza M. Visits to Sexually Transmitted Infection Clinics in Italy from January 2016 to November 2021: A Multicenter, Retrospective Study. J Pers Med 2023; 13:jpm13050731. [PMID: 37240901 DOI: 10.3390/jpm13050731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
There is no evidence of seasonal variation in visits to clinics dedicated to sexually transmitted infections (STIs) in Italy, nor of changes after the advent of the COVID-19 pandemic. An observational, retrospective, multicentric study was conducted to record and analyze all the visits to the STI clinics of the Dermatology Units of the University Hospitals of Ferrara and Bologna and of the Infectious Disease Unit of Ferrara, Italy, between January 2016 and November 2021. Overall, 11.733 visits were registered over a 70-month study period (63.7% males, mean age 34.5 ± 12.8 yrs). The mean number of monthly visits significantly decreased from the advent of the pandemic (136) compared to before (177). In the pre-pandemic period, visits to STI clinics increased in the autumn/winter months when compared to spring/summer, while the trend was the opposite in the pandemic period. Thus, during the pandemic, both an overall significant reduction in visits to STI clinics and a reversal in their seasonality were observed. These trends affected males and females equally. The marked decrease, mostly found in the pandemic winter months, can be linked to the "lockdown"/self-isolation ordinances and social distancing measures during the colder months, coinciding with the spread of the COVID-19 infection, which limited the opportunities for meeting and socializing.
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Affiliation(s)
- Alessandro Borghi
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Lucrezia Pacetti
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, 44121 Ferrara, Italy
| | - Gionathan Orioni
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Elisa Marzola
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, 44121 Ferrara, Italy
| | - Rosario Cultrera
- Infectious Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Valentina Guerra
- Planning and Management Control, University Hospital of Ferrara, 44124 Cona, Italy
| | - Roberto Manfredini
- University Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Valeria Gaspari
- Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40126 Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Daniela Segala
- Infectious Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Monica Corazza
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, 44121 Ferrara, Italy
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Bussolati E, Cultrera R, Quaranta A, Cricca V, Marangoni E, La Rosa R, Bertacchini S, Bellonzi A, Ragazzi R, Volta CA, Spadaro S, Scaramuzzo G. Effect of the Pandemic Outbreak on ICU-Associated Infections and Antibiotic Prescription Trends in Non-COVID19 Acute Respiratory Failure Patients. J Clin Med 2022; 11:jcm11237080. [PMID: 36498656 PMCID: PMC9739506 DOI: 10.3390/jcm11237080] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic had a relevant impact on the organization of intensive care units (ICU) and may have reduced the overall compliance with healthcare-associated infections (HAIs) prevention programs. Invasively ventilated patients are at high risk of ICU-associated infection, but there is little evidence regarding the impact of the pandemic on their occurrence in non-COVID-19 patients. Moreover, little is known of antibiotic prescription trends in the ICU during the first wave of the pandemic. The purpose of this investigation is to assess the incidence, characteristics, and risk factors for ICU-associated HAIs in a population of invasively ventilated patients affected by non-COVID-19 acute respiratory failure (ARF) admitted to the ICU in the first wave of the COVID-19 pandemic, and to evaluate the ICU antimicrobial prescription strategies. Moreover, we compared HAIs and antibiotic use to a cohort of ARF patients admitted to the ICU the year before the pandemic during the same period. METHODS this is a retrospective, single-centered cohort study conducted at S. Anna University Hospital (Ferrara, Italy). We enrolled patients admitted to the ICU for acute respiratory failure requiring invasive mechanical ventilation (MV) between February and April 2020 (intra-pandemic group, IP) and February and April 2019 (before the pandemic group, PP). We excluded patients admitted to the ICU for COVID-19 pneumonia. We recorded patients' baseline characteristics, ICU-associated procedures and devices. Moreover, we evaluated antimicrobial therapy and classified it as prophylactic, empirical or target therapy, according to the evidence of infection at the time of prescription and to the presence of a positive culture sample. We compared the results of the two groups (PP and IP) to assess differences between the two years. RESULTS One hundred and twenty-eight patients were screened for inclusion and 83 patients were analyzed, 45 and 38 in the PP and I group, respectively. We found a comparable incidence of HAIs (62.2% vs. 65.8%, p = 0.74) and multidrug-resistant (MDR) isolations (44.4% vs. 36.8% p= 0.48) in the two groups. The year of ICU admission was not independently associated with an increased risk of developing HAIs (OR = 0.35, 95% CI 0.16-1.92, p = 0.55). The approach to antimicrobial therapy was characterized by a significant reduction in total antimicrobial use (21.4 ± 18.7 vs. 11.6 ± 9.4 days, p = 0.003), especially of target therapy, in the IP group. CONCLUSIONS ICU admission for non-COVID-19 ARF during the first wave of the SARS-CoV-2 pandemic was not associated with an increased risk of ICU-associated HAIs. Nevertheless, ICU prescription of antimicrobial therapy changed and significantly decreased during the pandemic.
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Affiliation(s)
- Enrico Bussolati
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Rosario Cultrera
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Alessandra Quaranta
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Valentina Cricca
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Elisabetta Marangoni
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Riccardo La Rosa
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
| | - Sara Bertacchini
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Alessandra Bellonzi
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Riccardo Ragazzi
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Carlo Alberto Volta
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
| | - Gaetano Scaramuzzo
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy
- Intensive Care Unit, Azienda Ospedaliera Universitaria Sant’Anna, 44121 Ferrara, Italy
- Correspondence:
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Maranini B, Ciancio G, Cultrera R, Govoni M. Reply to: "Herpes zoster seven days after SARS-CoV-2 vaccination in a patient with ankylosing spondylitis under adalimumab" by Josef Finsterer. Reumatismo 2022; 74. [PMID: 35506316 DOI: 10.4081/reumatismo.2022.1482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Not available.
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Affiliation(s)
- B Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - G Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - R Cultrera
- Infectious Diseases, Department of Translational Medicine, University of Ferrara.
| | - M Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
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Maranini B, Ciancio G, Ferracin M, Cultrera R, Negrini M, Sabbioni S, Govoni M. microRNAs and Inflammatory Immune Response in SARS-CoV-2 Infection: A Narrative Review. Life (Basel) 2022; 12:life12020288. [PMID: 35207576 PMCID: PMC8879390 DOI: 10.3390/life12020288] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/15/2022] Open
Abstract
The current SARS-CoV-2 pandemic has emerged as an international challenge with strong medical and socioeconomic impact. The spectrum of clinical manifestations of SARS-CoV-2 is wide, covering asymptomatic or mild cases up to severe and life-threatening complications. Critical courses of SARS-CoV-2 infection are thought to be driven by the so-called “cytokine storm”, derived from an excessive immune response that induces the release of proinflammatory cytokines and chemokines. In recent years, non-coding RNAs (ncRNAs) emerged as potential diagnostic and therapeutic biomarkers in both inflammatory and infectious diseases. Therefore, the identification of SARS-CoV-2 miRNAs and host miRNAs is an important research topic, investigating the host–virus crosstalk in COVID-19 infection, trying to answer the pressing question of whether miRNA-based therapeutics can be employed to tackle SARS-CoV-2 complications. In this review, we aimed to directly address ncRNA role in SARS-CoV-2-immune system crosstalk upon COVID-19 infection, particularly focusing on inflammatory pathways and cytokine storm syndromes.
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Affiliation(s)
- Beatrice Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (G.C.); (M.G.)
- Correspondence:
| | - Giovanni Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (G.C.); (M.G.)
| | - Manuela Ferracin
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, 40138 Bologna, Italy;
| | - Rosario Cultrera
- Infectious Diseases, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Massimo Negrini
- Laboratorio per le Tecnologie delle Terapie Avanzate (LTTA), Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Silvia Sabbioni
- Department of Life Sciences and Biotechnologies, University of Ferrara, 44121 Ferrara, Italy;
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy; (G.C.); (M.G.)
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Maranini B, Ciancio G, Cultrera R, Govoni M. Herpes zoster infection following mRNA COVID-19 vaccine in a patient with ankylosing spondylitis. Reumatismo 2021; 73. [PMID: 34814659 DOI: 10.4081/reumatismo.2021.1445] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022] Open
Abstract
Since the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) pandemic outbreak, vaccines gained a growing role. Possible vaccine-related side effects range from minor local events to more prominent systemic manifestations up to anaphylactic reactions. A heterogeneous spectrum of cutaneous reactions has been reported, ranging from local injection site reactions to urticarial and morbilliform eruptions, pernio/chilblains and zoster flares. Here, we describe a case of varicella zoster virus reactivation following mRNA coronavirus 2019 vaccine and discuss the available literature upon the topic published so far.
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Affiliation(s)
- B Maranini
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - G Ciancio
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
| | - R Cultrera
- Infectious Diseases, Department of Translational Medicine, University of Ferrara.
| | - M Govoni
- Rheumatology Unit, Department of Medical Sciences, University of Ferrara.
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Braccia A, Carta F, Fiorillo D, Tecilla G, Cesnik E, Fallica E, Govoni V, Cultrera R. A case of limbic encephalitis with CSF detection of sars-cov2 virus: Immune-mediated mechanism or direct viral damage? J Neurol Sci 2021. [PMCID: PMC8498560 DOI: 10.1016/j.jns.2021.119783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Malagù M, Vitali F, Brieda A, Cimaglia P, De Raffele M, Tazzari E, Musolino C, Balla C, Serenelli M, Cultrera R, Rapezzi C, Bertini M. Antibiotic prophylaxis based on individual infective risk stratification in cardiac implantable electronic device: the PRACTICE study. Europace 2021; 24:413-420. [PMID: 34487163 PMCID: PMC8892070 DOI: 10.1093/europace/euab222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/02/2021] [Indexed: 11/23/2022] Open
Abstract
Aims In patients undergoing cardiac implantable electronic device (CIED) intervention, routine pre-procedure antibiotic prophylaxis is recommended. A more powerful antibiotic protocol has been suggested in patients at high risk of infection. Stratification of individual infective risk could guide the prophylaxis before CIED procedure. Methods and results Patients undergoing CIED surgery were stratified according to the Shariff score in low and high infective risk. Patients in the ‘low-risk’ group were treated with only two antibiotic administrations while patients in the ‘high-risk’ group were treated with a prolonged 9-day protocol, according to renal function and allergies. We followed-up patients for 250 days with clinical outpatient visit and electronic control of the CIED. As primary endpoint, we evaluated CIED-related infections. A total of 937 consecutive patients were enrolled, of whom 735 were stratified in the ‘low-risk’ group and 202 in the ‘high-risk’ group. Despite different risk profiles, CIED-related infection rate at 250 days was similar in the two groups (8/735 in ‘low risk’ vs. 4/202 in ‘high risk’, P = 0.32). At multivariate analysis, active neoplasia, haematoma, and reintervention were independently associated with CIED-related infection (HR 5.54, 10.77, and 12.15, respectively). Conclusion In a large cohort of patients undergoing CIED procedure, an antibiotic prophylaxis based on individual stratification of infective risk resulted in similar rate of infection between groups at high and low risk of CIED-related infection.
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Affiliation(s)
- Michele Malagù
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Francesco Vitali
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Alessandro Brieda
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Paolo Cimaglia
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Martina De Raffele
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Enea Tazzari
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Cristina Musolino
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Cristina Balla
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Matteo Serenelli
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Rosario Cultrera
- Infectious Disease Unit, S. Anna University Hospital, Ferrara, Italy
| | - Claudio Rapezzi
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
| | - Matteo Bertini
- Cardiological Center, S. Anna University Hospital, Via Aldo Moro 8, 44124 Cona Ferrara, Italy
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Cultrera R, Barozzi A, Libanore M, Marangoni E, Pora R, Quarta B, Spadaro S, Ragazzi R, Marra A, Segala D, Volta CA. Co-Infections in Critically Ill Patients with or without COVID-19: A Comparison of Clinical Microbial Culture Findings. Int J Environ Res Public Health 2021; 18:ijerph18084358. [PMID: 33923992 PMCID: PMC8073702 DOI: 10.3390/ijerph18084358] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 01/08/2023]
Abstract
Co-infections in critically ill patients hospitalized for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have an important impact on the outcome of coronavirus disease 2019 (COVID-19). We compared the microbial isolations found in COVID-19 patients hospitalized in an intensive care unit (ICU) with those in a non-COVID-19 ICU from 22 February to 30 April 2020 and in the same period of 2019. We considered blood, urine or respiratory specimens obtained with bronchoalveolar lavage (BAL) or bronchial aspirate (BASP), collected from all patients admitted in ICUs with or without COVID-19 infection. We found a higher frequency of infections due to methicillin-resistant (MR) staphylococci, vancomycin-resistant Enterococcus faecium, carbapenem-resistant Acinetobacter baumannii and Candida parapsilosis in COVID-19-positive patients admitted in ICUs compared to those who were COVID-19 negative. Carbapenem-resistant Pseudomonas aeruginosa was more frequently isolated from patients admitted in non-COVID-19 ICUs. Several conditions favor the increased frequency of these infections by antibiotic-resistant microorganisms. Among all, the severity of the respiratory tracts was definitely decisive, which required assisted ventilation with invasive procedures. The turnover in the ICU of a large number of patients in a very short time requiring urgent invasive interventions has favored the not always suitable execution of assistance procedures. No less important is the increased exposure to infectious risk from bacteria and fungi in patients with severe impairment due to ventilation. The highest costs for antifungal drugs were shown in the ICU-COVID group.
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Affiliation(s)
- Rosario Cultrera
- Infectious Diseases, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy;
- Correspondence: ; Tel.: +39-0532239145 or +39-3473628614
| | - Agostino Barozzi
- Clinical Microbiology, Department of Biotechnology, Transfusional and Laboratory, University Hospital of Ferrara, 44124 Ferrara, Italy; (A.B.); (R.P.)
| | - Marco Libanore
- Infectious Diseases Unit, Department of Medicine, University Hospital of Ferrara, 44124 Ferrara, Italy;
| | - Elisabetta Marangoni
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
| | - Roberto Pora
- Clinical Microbiology, Department of Biotechnology, Transfusional and Laboratory, University Hospital of Ferrara, 44124 Ferrara, Italy; (A.B.); (R.P.)
| | - Brunella Quarta
- Pharmacy Service, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.Q.); (A.M.)
| | - Savino Spadaro
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
| | - Riccardo Ragazzi
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
| | - Anna Marra
- Pharmacy Service, University Hospital of Ferrara, 44124 Ferrara, Italy; (B.Q.); (A.M.)
| | - Daniela Segala
- Infectious Diseases, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy;
| | - Carlo Alberto Volta
- Intensive Care Unit, Department of Traslational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (S.S.); (R.R.); (C.A.V.)
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Cultrera R, Torelli R, Sarnicola C, Segala D, Mengoli A, Chiaretto G, Perri P, Sanguinetti M. Identification and molecular characterization of Subramaniula asteroides causing human fungal keratitis: a case report. BMC Infect Dis 2021; 21:82. [PMID: 33461505 PMCID: PMC7814578 DOI: 10.1186/s12879-021-05768-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Keratitis due to by filamentous fungi are not easy to diagnose thus causing a delay in correct therapy. There are many descriptions of keratitis due to Candida, Fusarium and Aspergillus genera. Subramaniula genus has only recently been reported to cause human infections and there are few descriptions of eye infections due to this filamentous fungus. Diagnosis of fungal keratitis is usually based on microscopic and cultural techniques of samples obtained by corneal swabbing or scraping. Considering the amount of time required to obtain culture results it is wise to use other diagnostic methods, such as molecular analyses. Therapeutic options against these fungi are limited by low tissue penetration in the eye due to ocular barriers. We describe the first case of S. asteroides human keratitis treated with isavuconazole. Case presentation We describe a rare case of fungal keratitis unresponsive to antimicrobial treatment in a 65-year-old male patient without a history of diabetes or immunological diseases. He reported that the onset of symptoms occurred during a long holiday in Cape Verde Island. Initial treatment with topical antibiotics associated to steroids were ineffective, allowing a slow clinical progression of disease to corneal perforation. On admission in our Hospital, slit-lamp examination of the left eye showed conjunctival congestion and hyperemia, a large inferior corneal ulceration with brown pigment, corneal edema, about 3 mm of hypopyon and irido-lenticular synechiae. The slow clinical progression of the disease to corneal perforation and the aspect of the ulcer were consistent with a mycotic etiology. Molecular methods used on fungal colonies isolated by Sabouraud’s dextrose agar cultures allowed the identification of Subramaniula asteroids from corneal scraping. Antimicrobial test showed a good susceptibility of this filamentous fungus to voriconazole and isavuconazole. Moreover, this fungal keratitis was successfully treated with isavuconazole, without side effects, observing a progressive clinical improvement. Conclusions Molecular methods may be useful for the identification of filamentous fungal keratitis on scraping samples thus shortening the time of diagnosis. Systemic therapy by isavuconazole could be useful to treat the filamentous fungal keratitis, reducing the possible adverse effects due to the use of voriconazole by systemic administration.
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Affiliation(s)
- Rosario Cultrera
- Department of Morphology, Surgery and Experimental Medicine, Infectious Diseases Unit, University 'S. Anna' Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Caterina Sarnicola
- Department of Biomedical and Surgical Sciences, Ophthalmology Unit, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Daniela Segala
- Department of Morphology, Surgery and Experimental Medicine, Infectious Diseases Unit, University 'S. Anna' Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Andrea Mengoli
- Department of Biomedical and Surgical Sciences, Ophthalmology Unit, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Giuseppina Chiaretto
- Clinical Microbiology, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Paolo Perri
- Department of Biomedical and Surgical Sciences, Ophthalmology Unit, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
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11
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Govoni B, Zurlo A, De Giorgio R, Cultrera R, Volpato S. Clostridium difficile infection in a Geriatric Care Unit: clinical characteristics and prognosis. JGG 2020. [DOI: 10.36150/2499-6564-419] [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: 11/06/2022]
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12
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Mele D, Flamigni F, Cultrera R, Cittanti C, Chiodi E, Fiorencis A, Ferrari R. [Role of cardiac imaging in the diagnosis of infective endocarditis]. G Ital Cardiol (Rome) 2020; 21:878-889. [PMID: 33077994 DOI: 10.1714/3455.34442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infective endocarditis is an increasingly common disease in the hospital setting. Although the 2015 guidelines of the European Society of Cardiology deal extensively with many aspects of infective endocarditis, there are still unsolved problems related to diagnosis, in particular to the appropriate use of cardiac imaging methods, that require further study. The aim of this review is to analyze the advantages and limitations of the echocardiographic, radiological and nuclear imaging methods in order to identify diagnostic pathways applicable in clinical practice.
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Affiliation(s)
- Donato Mele
- Centro Cardiologico Universitario e LTTA Centre, Università degli Studi, Ferrara
| | - Filippo Flamigni
- Centro Cardiologico Universitario e LTTA Centre, Università degli Studi, Ferrara
| | | | | | | | - Andrea Fiorencis
- Centro Cardiologico Universitario e LTTA Centre, Università degli Studi, Ferrara
| | - Roberto Ferrari
- Centro Cardiologico Universitario e LTTA Centre, Università degli Studi, Ferrara - Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola (RA)
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13
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Cultrera R, Libanore M, Barozzi A, d’Anchera E, Romanini L, Fabbian F, De Motoli F, Quarta B, Stefanati A, Bolognesi N, Gabutti G. Ceftolozane/Tazobactam and Ceftazidime/Avibactam for Multidrug-Resistant Gram-Negative Infections in Immunocompetent Patients: A Single-Center Retrospective Study. Antibiotics (Basel) 2020; 9:E640. [PMID: 32987821 PMCID: PMC7598694 DOI: 10.3390/antibiotics9100640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 07/29/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022] Open
Abstract
Complicated infections from multidrug-resistant Gram-negative bacteria (MDR-GNB) represent a serious problem presenting many challenges. Resistance to many classes of antibiotics reduces the probability of an adequate empirical treatment, with unfavorable consequences, increasing morbidity and mortality. Readily available patient medical history and updated information about the local microbiological epidemiology remain critical for defining the baseline risk of MDR-GNB infections and guiding empirical treatment choices, with the aim of avoiding both undertreatment and overtreatment. There are few literature data that report real-life experiences in the use of ceftolozane/tazobactam and ceftazidime/avibactam, with particular reference to microbiological cure. Some studies reported experiences for the treatment of MDR-GNB infections in patients with hematological malignancies or specifically in Pseudomonas aeruginosa infections. We report our clinical single-center experience regarding the real-life use of ceftolozane/tazobactam and ceftazidime/avibactam to treat serious and complicated infections due to MDR-GNB and carbapenem-resistant Enterobacterales (CRE), with particular regard given to intra-abdominal and urinary tract infections and sepsis.
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Affiliation(s)
- Rosario Cultrera
- Infectious and Tropical Diseases, Department of Morphology, Surgery and Experimental Medicine, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Marco Libanore
- Infectious Diseases Unit, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Agostino Barozzi
- Clinical Microbiology, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (L.R.)
| | - Erica d’Anchera
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Via Fossato Di Mortara 64/B, 44121 Ferrara, Italy; (E.d.); (F.D.M.); (N.B.)
| | - Letizia Romanini
- Clinical Microbiology, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy; (A.B.); (L.R.)
| | - Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Francesco De Motoli
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Via Fossato Di Mortara 64/B, 44121 Ferrara, Italy; (E.d.); (F.D.M.); (N.B.)
| | - Brunella Quarta
- Department of Pharmacy, University ‘S. Anna’ Hospital of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy;
| | - Armando Stefanati
- Public Health Medicine Section, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121 Ferrara, Italy;
| | - Niccolò Bolognesi
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Via Fossato Di Mortara 64/B, 44121 Ferrara, Italy; (E.d.); (F.D.M.); (N.B.)
| | - Giovanni Gabutti
- Public Health Medicine Section, Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64/B, 44121 Ferrara, Italy;
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14
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Balla C, Brieda A, Righetto A, Vitali F, Malagù M, Cultrera R, Bertini M. Predictors of infection after "de novo" cardiac electronic device implantation. Eur J Intern Med 2020; 77:73-78. [PMID: 32127301 DOI: 10.1016/j.ejim.2020.02.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiac implantable electronic device (CIED) infection is a major complication that increases morbidity and mortality after the procedure. Several infection risk scores have been suggested to identify patients at higher pre-procedural risk of infection OBJECTIVE: this study sought to evaluate rates of infection, potential risk factors and the role of a modified "Shariff" score as predictor of infection in high-risk patients undergoing de novo CIED implantation. METHODS AND RESULTS We retrospectively analysed 1391 patients underwent a de novo CIED procedure during the study period. At the median follow-up of 48 months, 20 patients of 1391 (1.4%) developed a CIED-related infective event. In our population, we studied a modified version of the "Shariff" score for only first-time implant patients. At multivariate regression analysis, three factors were independent predictors of infection: previous pocket hematoma [RR 27.2 (8.30-54.02), p = 10-10], a Shariff Score ≥ 4 [RR 3.20 (1.29-12.59), p= 0.029]. and reintervention for catheter malfunction or dislocation [RR 3.57 (1.2-37.4), p= 0.048]. CONCLUSIONS a "Shariff" score > 4 is suggested as a predictor of higher risk of infection in patients after de novo device implantation. The use of an infection risk score may help to improve tailored pre-operatory strategies to prevent infection.
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Affiliation(s)
- C Balla
- Cardiovascular Institute, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy.
| | - A Brieda
- Cardiovascular Institute, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - A Righetto
- Cardiovascular Institute, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - F Vitali
- Cardiovascular Institute, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - M Malagù
- Cardiovascular Institute, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy; Infectious Diseases, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - R Cultrera
- Infectious Diseases, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
| | - M Bertini
- Cardiovascular Institute, Department of Medical Sciences, University of Ferrara, Azienda Ospedaliero-Universitaria di Ferrara, Cona (FE), Italy
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15
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Tumbarello M, Trecarichi EM, Corona A, De Rosa FG, Bassetti M, Mussini C, Menichetti F, Viscoli C, Campoli C, Venditti M, De Gasperi A, Mularoni A, Tascini C, Parruti G, Pallotto C, Sica S, Concia E, Cultrera R, De Pascale G, Capone A, Antinori S, Corcione S, Righi E, Losito AR, Digaetano M, Amadori F, Giacobbe DR, Ceccarelli G, Mazza E, Raffaelli F, Spanu T, Cauda R, Viale P. Efficacy of Ceftazidime-Avibactam Salvage Therapy in Patients With Infections Caused by Klebsiella pneumoniae Carbapenemase-producing K. pneumoniae. Clin Infect Dis 2020; 68:355-364. [PMID: 29893802 DOI: 10.1093/cid/ciy492] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/06/2018] [Indexed: 12/21/2022] Open
Abstract
Background Ceftazidime-avibactam (CAZ-AVI) has been approved in Europe for the treatment of complicated intra-abdominal and urinary tract infections, as well as hospital-acquired pneumonia, and for gram-negative infections with limited treatment options. CAZ-AVI displays in vitro activity against Klebsiella pneumoniae carbapenemase (KPC) enzyme producers, but clinical trial data on its efficacy in this setting are lacking. Methods We retrospectively reviewed 138 cases of infections caused by KPC-producing K. pneumoniae (KPC-Kp) in adults who received CAZ-AVI in compassionate-use programs in Italy. Case features and outcomes were analyzed, and survival was then specifically explored in the large subcohort whose infections were bacteremic. Results The 138 patients started CAZ-AVI salvage therapy after a first-line treatment (median, 7 days) with other antimicrobials. CAZ-AVI was administered with at least 1 other active antibiotic in 109 (78.9%) cases. Thirty days after infection onset, 47 (34.1%) of the 138 patients had died. Thirty-day mortality among the 104 patients with bacteremic KPC-Kp infections was significantly lower than that of a matched cohort whose KPC-Kp bacteremia had been treated with drugs other than CAZ-AVI (36.5% vs 55.8%, P = .005). Multivariate analysis of the 208 cases of KPC-Kp bacteremia identified septic shock, neutropenia, Charlson comorbidity index ≥3, and recent mechanical ventilation as independent predictors of mortality, whereas receipt of CAZ-AVI was the sole independent predictor of survival. Conclusions CAZ-AVI appears to be a promising drug for treatment of severe KPC-Kp infections, especially those involving bacteremia.
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Affiliation(s)
- Mario Tumbarello
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Università Cattolica del Sacro Cuore, Rome
| | - Enrico Maria Trecarichi
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Università Cattolica del Sacro Cuore, Rome
| | - Alberto Corona
- Intensive Care Unit Department of Emergency, Luigi Sacco Hospital-Azienda Socio Sanitaria Territoriale (ASST)-Fatebenefratelli Sacco, University of Milan
| | | | - Matteo Bassetti
- Infectious Disease Division, Santa Maria Misericordia University Hospital, Udine
| | - Cristina Mussini
- Clinica delle Malattie Infettive, Università di Modena e Reggio Emilia
| | | | - Claudio Viscoli
- Infectious Diseases Division, Università di Genova e Ospedale Policlinico San Martino IRCCS per l'oncologia e le neuroscienze, Genoa
| | - Caterina Campoli
- Infectious Diseases Unit, Department of Medical and Clinical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna
| | - Mario Venditti
- Dipartimento di Salute Pubblica e Malattie Infettive, Policlinico Umberto I Università 'Sapienza', Rome
| | | | - Alessandra Mularoni
- Infectious Diseases Istituto mediterraneo per i trapianti e terapie ad alta specializzazione-IRCCS Palermo
| | - Carlo Tascini
- Prima divisione di Malattie Infettive, Ospedale Cotugno, Azienda Ospedaliera dei Colli, Napoli
| | - Giustino Parruti
- Unità Operativa Complessa Malattie Infettive, Azienda Unità Sanitaria Locale Pescara
| | - Carlo Pallotto
- Infectious Diseases Section, Department of Medicine, University of Perugia
| | - Simona Sica
- Institute of Hematology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome
| | - Ercole Concia
- Malattie Infettive, Ospedale Universitario di Verona
| | - Rosario Cultrera
- Malattie Infettive, Dipartimento di Scienze Mediche, Università degli Studi di Ferrara
| | - Gennaro De Pascale
- Department of Intensive Care and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome
| | - Alessandro Capone
- Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani IRCCS Rome
| | - Spinello Antinori
- Department of Clinical and Biomedical Sciences "L. Sacco," University of Milan
| | | | - Elda Righi
- Infectious Disease Division, Santa Maria Misericordia University Hospital, Udine
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Università Cattolica del Sacro Cuore, Rome
| | | | | | - Daniele Roberto Giacobbe
- Infectious Diseases Division, Università di Genova e Ospedale Policlinico San Martino IRCCS per l'oncologia e le neuroscienze, Genoa
| | - Giancarlo Ceccarelli
- Dipartimento di Salute Pubblica e Malattie Infettive, Policlinico Umberto I Università 'Sapienza', Rome
| | - Ernestina Mazza
- Anestesia Rianimazione 2-ASST ospedale Niguarda Ca Granda, Milan
| | - Francesca Raffaelli
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Università Cattolica del Sacro Cuore, Rome
| | - Teresa Spanu
- Institute of Microbiology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberto Cauda
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli - Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS)-Università Cattolica del Sacro Cuore, Rome
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Clinical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna
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16
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Caio G, Lungaro L, Cultrera R, De Giorgio R, Volta U. Coronaviruses and gastrointestinal symptoms: an old liaison for the new SARS-CoV-2. Gastroenterol Hepatol Bed Bench 2020; 13:341-350. [PMID: 33244376 PMCID: PMC7682957] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/08/2020] [Indexed: 11/12/2022]
Abstract
The coronavirus disease (Covid-19) has caused a pandemic with more than 600,000 deaths to date. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a member of the beta-coronavirus genus that also includes SARS and the Middle East Respiratory Syndrome Coronavirus (MERS). While the typical presentation is given by respiratory symptoms and fever, some patients also report gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Several studies have identified the SARS-CoV-2 RNA in stool specimens of infected patients, and its viral receptor angiotensin-converting enzyme 2 (ACE2) is highly expressed in enterocytes. In this short review, we report the frequency of gastrointestinal symptoms in infected patients and suggest possible implications for disease management, transmission, and infection control.
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Affiliation(s)
- Giacomo Caio
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara Italy
- Mucosal Immunology and Biology Research Center, Massachusetts General Hospital – Harvard Medical School, Boston, MA, USA
| | - Lisa Lungaro
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara Italy
| | - Rosario Cultrera
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara Italy
| | - Roberto De Giorgio
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara Italy
| | - Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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17
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Bortolotti D, Gentili V, Rotola A, Cultrera R, Marci R, Di Luca D, Rizzo R. HHV-6A infection of endometrial epithelial cells affects immune profile and trophoblast invasion. Am J Reprod Immunol 2019; 82:e13174. [PMID: 31338899 DOI: 10.1111/aji.13174] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 05/05/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/22/2022] Open
Abstract
PROBLEM We first reported human herpesvirus (HHV)-6A DNA presence in 43% of endometrial cells from women with idiopathic infertility, whereas no fertile control women harbored the virus. We investigated the effect of HHV-6A infection on the immunological status of the endometrium. METHOD OF STUDY Endometrial biopsies, uterine flushing, and whole blood samples were collected from 67 idiopathic infertile women (mid-secretory phase). We analyzed the endometrial immunological status evaluating: (a) the effect of HHV-6A infection on endometrial immune profile analyzing the ratio of interleukin (IL)-15/ fibroblast growth factor-inducible 14 (Fn-14) and IL-18/ TNF-related weak inducer of apoptosis (TWEAK) mRNA as a biomarker of endometrial (e)natural killer activation/maturation, angiogenesis, and Th1/Th2 balance; (b) endometrial receptivity to trophoblasts in endometrial 3D in vitro model; (c) natural killer (NK) cells and T cells percentage and subpopulations by flow cytometry. RESULTS We confirmed the presence of HHV-6A infection in a 40% of idiopathic infertile women, characterized by an immune profile reflecting eNK cell cytotoxic activation and a decrease in CD4+ CD25+ CD127dim/- regulatory T cells. The co-culture of endometrial epithelial cells with spheroids generated from the extravillous trophoblast-derived cell line JEG3 showed a twofold expansion of spheroids on endometrial epithelial-stromal cells (ESC) culture surface from HHV-6A negative women while no expansion was observed on the surface of ESC from HHV-6A positive women. CONCLUSION The identification of an effect of HHV-6A infection on endometrial immune status opens new perspectives in idiopathic infertile women care management. In addition, it would be possible to select antiviral therapies as novel, non-hormonal therapeutic approaches to those idiopathic infertile women characterized by the presence of endometrial HHV-6A infection, to increase their pregnancy rate.
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Affiliation(s)
- Daria Bortolotti
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Valentina Gentili
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Antonella Rotola
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosario Cultrera
- Department of Medical Sciences, Section of Dermathology and Infective Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto Marci
- Department of Morphology, Surgery and Experimental Medicine, Section of Orthopedics, Obstetrics and Gynecology and Anesthesiology and Reanimation Ferrara, University of Ferrara, Ferrara, Italy.,School of Medicine, University of Geneva, Geneva, Switzerland
| | - Dario Di Luca
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Roberta Rizzo
- Department of Chemical and Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy
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18
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Fabbian F, De Giorgi A, Boari B, Misurati E, Gallerani M, Cappadona R, Cultrera R, Manfredini R, Rodrìguez Borrego MA, Lopez-Soto PJ. Infections and internal medicine patients: Could a comorbidity score predict in-hospital mortality? Medicine (Baltimore) 2018; 97:e12818. [PMID: 30334978 PMCID: PMC6211916 DOI: 10.1097/md.0000000000012818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 11/25/2022] Open
Abstract
Infectious diseases (ID) are frequently cause of internal medicine wards (IMW) admission. We aimed to evaluate risk factors for in-hospital mortality (IHM) in IMW patients with ID, and to test the usefulness of a comorbidity score (CS).This study included ID hospital admissions between January 2013, and December 2016, recorded in the database of the local hospital. ICD-9-CM codes were selected to identify infections, development of sepsis, and to calculate a CS.We analyzed 12,173 records, (age 64.8 ± 25.1 years, females 66.2%, sepsis 9.3%). Deceased subjects (1545, 12.7%) were older, had higher percentage of sepsis, pulmonary infections, and endocarditis. Mean value of CS was also significantly higher. At multivariate analysis, the odds ratio (OR) for sepsis (OR 5.961), endocarditis (OR 4.247), pulmonary infections (OR 1.905), other sites of infection (OR 1.671), and urinary tracts infections (OR 0.548), were independently associated with IHM. The CS (OR 1.070 per unit of increasing score), was independently associated with IHM as well. The calculated weighted risk, obtained by multiplying 1.070 for the mean score value in deceased patients, was 19.367. Receiver operating characteristic (ROC) analysis showed that CS and development of sepsis were significant predictors for IHM (area under the curve, AUC: 0.724 and 0.670, respectively).Careful evaluation of comorbidity in internal medicine patients is nowadays matter of extreme importance in IMW patients hospitalized for ID, being IHM related to severity of disease, type and site of infection, and also to concomitant comorbidities. In these patients, a careful evaluation of CS should represent a fundamental step in the disease management.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Alfredo De Giorgi
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
| | - Benedetta Boari
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
| | - Elisa Misurati
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
| | - Massimo Gallerani
- First Internal Medicine Unit, Department of Internal Medicine, General Hospital of Ferrara
| | - Rosaria Cappadona
- Obstetrics and Gynecology Unit, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara
| | - Rosario Cultrera
- Infectious Diseases University Unit, Department of Medical Sciences, University of Ferrara, Italy
| | - Roberto Manfredini
- Clinica Medica Unit, Department of Medical Sciences, University of Ferrara
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Maria A. Rodrìguez Borrego
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Pablo J. Lopez-Soto
- Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba & Hospital Universitario Reina Sofía, Córdoba, Spain
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19
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Bortolotti D, Rossignoli F, Rotola A, Campioni D, Cultrera R, Grisendi G, Dominici M, Rizzo R. Human Herpes simplex 1 virus infection of endometrial decidual tissue-derived MSC alters HLA-G expression and immunosuppressive functions. Hum Immunol 2018; 79:800-808. [PMID: 30118778 DOI: 10.1016/j.humimm.2018.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Mesenchymal stromal/stem cells have immunosuppressive functions. Our previous results demonstrated that one of the players of this immunomodulation can be ascribed to the Human Leukocyte Antigen-G. HLA-G, a non classical HLA class I antigen, is involved in immune tolerance during pregnancy, organ transplantation, autoimmune and inflammatory diseases. In this study we wanted to verify whether human endometrial decidual tissue derived (EDT)-MSC could express HLA-G. Additionally we assessed the permissivity to Human Herpesvirus infections, using HSV-1 as a model, and the possible effect on EDT-MSC immunosuppressive functions towards peripheral blood mononuclear cell (PBMC) proliferation. METHODS We analyzed immune-inhibitory functions and HLA-G expression in human EDT-MSC before and after HSV-1 infection. RESULTS We observed that EDT-MSC express HLA-G molecules, that partly are responsible for the immune-inhibitory functions of EDT-MSC towards PBMC proliferation. EDT-MSC are permissive for a productive infection by HSV-1, that decreases HLA-G expression and affects EDT-MSC immune-inhibitory functions. CONCLUSIONS We demonstrate that EDT-MSC are susceptible to HSV-1 infection, that reduces HLA-G expression and their immune-inhibitory function. These data could have a clinical implication in the use of EDT-MSC as an immunosuppressant, in particular in steroid-refractory GvHD after allogeneic hematopoietic stem cell transplantation and in autoimmune diseases.
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Affiliation(s)
- Daria Bortolotti
- Section of Microbiology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Filippo Rossignoli
- Laboratory of Cellular Therapy, Department of Medical and Surgical Sciences for Children & Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Antonella Rotola
- Section of Microbiology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Diana Campioni
- Department of Specialist Biomedical and Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosario Cultrera
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Giulia Grisendi
- Laboratory of Cellular Therapy, Department of Medical and Surgical Sciences for Children & Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Dominici
- Laboratory of Cellular Therapy, Department of Medical and Surgical Sciences for Children & Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Roberta Rizzo
- Section of Microbiology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
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Antonioli P, Formaglio A, Gamberoni D, Bertoni L, Perrone P, Stefanati A, Libanore M, Cultrera R, Gabutti G. Hospital discharge in patients at risk of surgical site infection: antimicrobial stewardship at Ferrara University Hospital, Italy. J Prev Med Hyg 2018; 59:E139-E144. [PMID: 30083621 PMCID: PMC6069401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/27/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The appropriate use of antibiotics is a global priority in order to avoid antibiotic resistance. Up to 50% of antibiotics usage in hospital is inappropriate (e.g. prolonged surgical prophylaxis, "defensive medicine" approach). In 2015, at the Ferrara University Hospital, an antimicrobial stewardship intervention to reduce antimicrobial prescription at the time of hospital discharge in patients at risk of surgical site infection was implemented. This programme included: update meetings for health professionals, focused meetings for critical wards, reviews of some surgical prophylaxis protocols, recommendations to reduce broad-spectrum antimicrobials use, and planning of an audit. The purpose of this study has been to evaluate the effect of this antimicrobial stewardship programme. METHODS To evaluate the effect of this intervention, a study has been carried out including inpatients in surveillance for surgical site infection who had surgery during the last quarter of 2014 (pre-intervention group; 461 patients) and of 2015 (post-intervention group; 532 patients). RESULTS The proportion of patients with prescription of at least one antimicrobial at discharge decreased from 33% to 24.4% (p = 0.002). The most prescribed categories of antimicrobials in both groups were the combination of penicillins with beta-lactamase inhibitors (with prescription rate reduced from 21.9% to 18%; p = 0.13) and fluoroquinolones (from 8.2% to 3.2%; p < 0.001). CONCLUSIONS This statistically significant reduction in antimicrobial prescription after the intervention was registered without a change in surgical site infections rate (from 3.5% to 3.2%; p = 0.08). Therefore, this intervention was effective in reducing the antimicrobial prescription at discharge, without affecting patients' safety.
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Affiliation(s)
- P. Antonioli
- Department of Hospital Hygiene & Healthcare Associated Infection Risk Management, Coordination of Clinical Health Promotion Activities, Hospital Health Medical Management, Ferrara University Hospital, Ferrara, Italy
| | - A. Formaglio
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - D. Gamberoni
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - L. Bertoni
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - P. Perrone
- Postgraduate School of Hygiene and Preventive Medicine, University of Ferrara, Italy
| | - A. Stefanati
- Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Italy
| | - M. Libanore
- Hospital Infectious Diseases Clinic, Ferrara University Hospital, Ferrara, Italy
| | - R. Cultrera
- University Infectious Diseases Clinic, Ferrara University Hospital, Ferrara, Italy
| | - G. Gabutti
- Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Italy
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Costagliola C, Romano MR, Parmeggiani F, Dell'Omo R, Cultrera R. Epiretinal membrane in a 12-year-old immunocompetent girl with cytomegalovirus infection. Eur J Ophthalmol 2018; 19:1098-101. [DOI: 10.1177/112067210901900637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ciro Costagliola
- Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso
| | - Mario R. Romano
- Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso
| | - Francesco Parmeggiani
- Dipartimento di Discipline Medico-Chirurgiche della Comunicazione e del Comportamento, Sezione di Oculistica, Università degli Studi di Ferrara
| | - Roberto Dell'Omo
- Dipartimento di Scienze per la Salute, Università degli Studi del Molise, Campobasso
| | - Rosario Cultrera
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara - Italy
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Flacco ME, Manzoli L, Rosso A, Marzuillo C, Bergamini M, Stefanati A, Cultrera R, Villari P, Ricciardi W, Ioannidis JPA, Contopoulos-Ioannidis DG. Immunogenicity and safety of the multicomponent meningococcal B vaccine (4CMenB) in children and adolescents: a systematic review and meta-analysis. Lancet Infect Dis 2018; 18:461-472. [PMID: 29371070 DOI: 10.1016/s1473-3099(18)30048-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 10/17/2017] [Accepted: 11/01/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The multicomponent meningococcal serogroup B vaccine (4CMenB) has been licensed in more than 35 countries. However, uncertainties remain about the lowest number of doses required to induce satisfactory, persistent immune responses. We did a systematic review and meta-analysis to provide quantitative estimates for the immunogenicity, persistence of immunogenicity, and safety of 4CMenB vaccine in children and adolescents. METHODS For this systematic review and meta-analyses (proportion, head to head, and network), we searched MEDLINE, Scopus, Embase, and ClinicalTrials.gov from database inception to June 30, 2017, for randomised trials that compared the immunogenicity or safety of the 4CMenB vaccine with its originator meningococcal B recombinant vaccine or routine vaccines in children or adolescents. For proportion meta-analyses, we also included single arm trials and follow-up studies of randomised controlled trials. Trials that assessed immunogenicity against at least one of four Neisseria meningitidis serogroup B reference strains (44-76/SL, 5/99, NZ98/254, and M10713) and included participants younger than 18 years who had received two or more doses of the 4CMenB vaccine were eligible for inclusion. We requested individual patient-level data from study authors and extracted data from published reports and online trial registries. We did meta-analyses to assess 4CMenB safety and immunogenicity against the four reference strains 30 days after a primary immunisation course (three doses for children, two doses for adolescents), 30 days after the primary course plus one booster dose (children only), 6 months or more after primary course, and 6 months or more after the booster dose. FINDINGS 736 non-duplicate records were screened, and ten randomised trials and eight follow-on extension trials on 4CMenB met the inclusion criteria. In intention-to-treat analyses, the overall proportion of children and adolescents who achieved seroconversion 30 days after the primary course of 4CMenB was 92% (95% CI 89-95 [I2=95%, p<0·0001]) for the 44/76-SL strain, 91% (87-95 [I2=95%, p<0·0001]) for the 5/99 strain, 84% (77-90 [I2=97%, p<0·0001]) for the NZ98-254 strain, and 87% (68-99 [I2=97%, p<0·0001]) for the M10713 strain. 6 months after the primary course, the immunogenicity remained adequate to high against all three tested strains (5/99, 44/76-SL, and NZ98/254) in adolescents (≥77%), and against two of four strains (5/99 and 44/76-SL) in children (≥67%): the proportion of patients who achieved seroconversion substantially declined for M10713 (<50%) and NZ98/254 (<35%). A booster dose re-enhanced the proportion of patients who achieved seroconversion (≥93% for all strains). However, immunogenicity remained high 6 months after the booster dose for strains 5/99 (95%) and M10713 (75%) only, whereas the proportion of patients who achieved seroconversion against strains 44/76-SL and NZ98/254 returned to similar proportions recorded 6 months after the primary course (62% for 44/76-SL, 35% for NZ98/254). The incidence of potentially vaccine-related, acute serious adverse events in individuals receiving 4CMenB was low (5·4 per 1000 individuals), but was significantly higher than routine vaccines (1·2 per 1000 individuals). INTERPRETATION 4CMenB has an acceptable short-term safety profile. The primary course is sufficient to achieve a satisfactory immune response within 30 days of vaccination. A booster dose is required for children to prolong the protection against strain M10713, and the long-term immunogenicity against strain NZ98/254 remains suboptimal. FUNDING None.
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Affiliation(s)
- Maria Elena Flacco
- Department of Preventive Services, Local Health Authority of South Tyrol, Bolzano, Italy; Regional Healthcare Agency of Abruzzo, Pescara, Italy
| | - Lamberto Manzoli
- Regional Healthcare Agency of Abruzzo, Pescara, Italy; Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
| | - Annalisa Rosso
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Carolina Marzuillo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Mauro Bergamini
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Armando Stefanati
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosario Cultrera
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paolo Villari
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Walter Ricciardi
- Institute of Public Health, Catholic University of the Sacred Heart, Rome, Italy; Italian National Institute of Health, Rome, Italy
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University, Stanford, CA, USA; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Department of Statistics, School of Humanities and Sciences, Stanford University, Stanford, CA, USA
| | - Despina G Contopoulos-Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Department of Pediatrics, Division of Infectious Diseases, School of Medicine, Stanford University, Stanford, CA, USA
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Occhionorelli S, Zese M, Cultrera R, Lacavalla D, Albanese M, Vasquez G. Open Abdomen Management and Candida Infections: A Very Likely Link. Gastroenterol Res Pract 2017; 2017:5187620. [PMID: 29362562 PMCID: PMC5738572 DOI: 10.1155/2017/5187620] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Laparostomy can be applied in trauma, abdominal sepsis, intra-abdominal hypertension, or compartment syndrome. Systemic infections, especially if complicated by Candida, are associated with a high risk of mortality. METHODS This is a single-centre retrospective case series of 47 cases admitted to our Department, which required laparostomy procedure; we analyzed the type of surgery, temporary abdominal closure, duration of open abdomen, complications, SOFA score, mortality with Candida infections, and empirical or targeted antifungal therapy. RESULTS We found that patients with Candida infection were related with a statistically significant difference (p < 0.05) with a complication after OA closure, total complications, time elapsed after OA application, time spent on the first surgical OA application, type of temporary abdominal closure that is used, and duration of the open abdomen. The use of empirical and targeted antifungal therapy is related to the duration of open abdomen too. CONCLUSIONS Management of the OA is often burdened by sepsis or septic shock, especially when complicated by Candida infection. Candida score is a validated tool to identify patients who can be treated empirically, but every situation must be considered on an individual basis.
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Affiliation(s)
- Savino Occhionorelli
- Department of Morphology, Surgery and Experimental Medicine-University of Ferrara and Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Monica Zese
- Department of Morphology, Surgery and Experimental Medicine-University of Ferrara and Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Rosario Cultrera
- Department of Medical Sciences, Centre for International Cooperation and Development, Infectious Diseases Unit-University of Ferrara and Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Domenico Lacavalla
- Department of Morphology, Surgery and Experimental Medicine-University of Ferrara and Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Marco Albanese
- Department of Morphology, Surgery and Experimental Medicine-University of Ferrara and Sant'Anna University Hospital of Ferrara, Ferrara, Italy
| | - Giorgio Vasquez
- Department of Surgery, Emergency Surgery Service, Sant'Anna University Hospital, Ferrara, Italy
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Caruso G, Gerace E, Lorusso V, Cultrera R, Moretti L, Massari L. Squamous cell carcinoma in chronic osteomyelitis: a case report and review of the literature. J Med Case Rep 2016; 10:215. [PMID: 27491284 PMCID: PMC4973539 DOI: 10.1186/s13256-016-1002-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 09/29/2015] [Accepted: 07/06/2016] [Indexed: 01/24/2023] Open
Abstract
Background Chronic osteomyelitis is a challenging problem, and malignant transformation is a rare occurrence. We report a case of a patient with squamous cell carcinoma arising from an osteomyelitic hotbed and discuss through a literature review the etiopathogenesis, diagnosis, and treatment of this lesion. Case presentation A 69-year-old Italian man had sustained an exposed tibial fracture 40 years ago during a road accident, for which he had undergone various surgical osteosynthesis treatments with multiple antibiotic therapies. He presented to our hospital because of recurrence of a fistula at the proximal third of the anterior region of the tibia. For 2 months, we treated the lesion with antibiotics, and local medication with curettage. We saw no evidence of lesion improvement, and we advised the patient to undergo a knee amputation, which he refused. The alternative we chose was a surgical toilet of the osteomyelitic hotbed and used bioglass as a bone substitute. After 2 months of follow-up, we noticed a fulminating, budding formation in the area of the surgical wound that turned out to be a squamous cell carcinoma on biopsy. The patient again refused the amputation and underwent a wide-margin surgical debridement. After 2 months, the carcinoma recurred, and an above-the-knee amputation was performed. Conclusions Our experience with this case indicates that amputation is the most appropriate treatment for squamous carcinoma occurring in patients with chronic osteomyelitis. To avoid risks of lymphonodular and organ metastasization, this radical surgical procedure should not be delayed. Early diagnosis and timely therapy can prevent amputation only in selected cases. Surgeons who treat osteomyelitis and chronic wounds should be aware of the risk of tumor degeneration. Squamous cell carcinoma associated with chronic osteomyelitis has a low-grade malignancy, but implications of lymphonodular involvement and organ metastasis should not be excluded.
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Affiliation(s)
- Gaetano Caruso
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Emanuele Gerace
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Vincenzo Lorusso
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Rosario Cultrera
- Infectious Diseases Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Loredana Moretti
- Plastic and Reconstructive Surgery, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Leo Massari
- Orthopaedic and Traumatology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, University of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
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Contini C, Cultrera R, Seraceni S, Castellazzi M, Granieri E, Fainardi E. Cerebrospinal fluid molecular demonstration of Chlamydia pneumoniae DNA is associated to clinical and brain magnetic resonance imaging activity in a subset of patients with relapsing-remitting multiple sclerosis. Mult Scler 2016; 10:360-9. [PMID: 15327030 DOI: 10.1191/1352458504ms1049oa] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 11/05/2022]
Abstract
To further explore the link between Chlamydia pneumoniae and multiple sclerosis (MS), we examined cerebrospinal fluid (CSF) samples from 71 patients with MS and from 72 patients suffering from other inflammatory neurological disorders (OIND) or noninflammatory neurological disorders (NIND). All samples were analysed by a touchdown nested polymerase chain reaction (n-PCR) forC. pneumoniae with primer sets which amplify target sequence genes encoding the major outer membrane protein (MOMP), the16S rRNA and the Hsp- 70 protein. A molecular study was also performed to evaluate genetic diversity among isolates of C. pneumoniae and to compare chlamydial sequences. PCR was found positive in 36.6% of total MS, in 28.1% of OIND and in 37.5% of NIND patients, without any statistical differences among the various groups examined. CSF PCR evidence of C. pneumoniae was significantly more frequent in relapsing-remitting (RR) than in secondary progressive (SP) (PB-0.001) and in primary progressive (PP)MS (PB-0.05), in clinically active than in clinically stable MS (PB-0.05) and in MRI active than in MRI inactive MS(PB-0.001). The analysis of CSF expression of each single C. pneumoniae-specific gene revealed that detectable levels of MOMP were significantly more frequent in MS patients with relapse (PB-0.05), whereas PCR positivity for MOMP and 16S rRNA genes were more represented in MS patients with clinical and MRI evidence of disease activity (PB-0.05). Similar rates for MOMP and 16S rRNA genes were detected in CSF of both MS patients and controls, whereas CSF PCR positivity for Hsp-70 gene was observed in only three active RR MS patients. Sequence analysis revealed significant homologies withC. pneumoniae compared to otherChlamydial spp. These findings confirm that theC. pneumoniae detection within the central nervous system (CNS) is not selectively restricted to MS, but accounts in a variety of neurological diseases. In addition, our results suggest that CSF C. pneumoniae-specific DNA detection can occur in a subset of MS patients with clinical and MRI active RR form in whom a C. pneumoniae brain chronic persistent infection may play a significant role in the development of disease.
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Affiliation(s)
- C Contini
- Section of Infectious Diseases, Department of Clinical & Experimental Medicine, University of Ferrara, via Fossato di Mortara, 23, 1-44100 Ferrara, Italy.
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De Bonis P, Lofrese G, Scoppettuolo G, Spanu T, Cultrera R, Labonia M, Cavallo MA, Mangiola A, Anile C, Pompucci A. Intraventricular versus intravenous colistin for the treatment of extensively drug resistant Acinetobacter baumannii meningitis. Eur J Neurol 2015; 23:68-75. [PMID: 26228051 DOI: 10.1111/ene.12789] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [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: 04/13/2015] [Accepted: 06/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Reports on the safety and efficacy of intraventricularly administered (IVT) colistin for the treatment of Acinetobacter baumannii ventriculomeningitis in adults are limited and no comparative studies of IVT colistin versus intravenous (IV) therapy alone have been published. This study compared outcomes of patients with postneurosurgical ventriculomeningitis caused by extensively drug-resistant A. baumannii treated with IV colistin or IV plus IVT colistin. METHODS In an 11-year period, information on 18 consecutive patients with extensively drug-resistant A. baumannii ventriculomeningitis was collected. Infection was defined on the basis of (i) isolation of A. baumannii from the cerebrospinal fluid (CSF); (ii) laboratory evidence of CSF infection; (iii) signs/symptoms of central nervous system (CNS) infection. Patients were divided into group 1 (nine patients, IV colistin alone) and group 2 (nine patients, IV plus IVT colistin). RESULTS Cerebrospinal fluid sterilization was documented for 12 of 18 patients (66.6%). The CSF sterilization rate was 33.3% in group 1 and 100% in group 2 (P = 0.009). The mean time to CSF sterilization was 21 days (range 8-48). Five patients died due to A. baumannii CNS infection (all in group 1), and five deaths were unrelated to A. baumannii ventriculomeningitis. Intensive care unit mean length of stay was shorter in group 2 (20.7 vs. 41.6 days, P = 0.046). Crude relative risk ratio of cumulative incidence of persistent CNS infection in group 1 versus group 2 was 13. No cases of chemical meningitis due to intrathecal colistin administration were encountered. CONCLUSIONS Intraventricular colistin administration is much more effective than IV therapy alone and does not seem to add further toxicity.
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Affiliation(s)
- P De Bonis
- Neurosurgery, Catholic University School of Medicine, Rome, Italy.,Neurosurgery, University Hospital S. Anna, Ferrara, Italy
| | - G Lofrese
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - G Scoppettuolo
- Infectious Diseases, Catholic University School of Medicine, Rome, Italy
| | - T Spanu
- Microbiology, Catholic University School of Medicine, Rome, Italy
| | - R Cultrera
- Infectious Diseases, University Hospital S. Anna, Ferrara, Italy
| | - M Labonia
- Department of Laboratory Medicine and Transfusion Medicine, Hospital for Research and Care Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - M A Cavallo
- Neurosurgery, University Hospital S. Anna, Ferrara, Italy
| | - A Mangiola
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - C Anile
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
| | - A Pompucci
- Neurosurgery, Catholic University School of Medicine, Rome, Italy
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Fabbian F, De Giorgi A, López-Soto PJ, Pala M, Tiseo R, Cultrera R, Gallerani M, Manfredini R. Is female gender as harmful as bacteria? analysis of hospital admissions for urinary tract infections in elderly patients. J Womens Health (Larchmt) 2015; 24:587-92. [PMID: 25950579 DOI: 10.1089/jwh.2014.5140] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are common bacterial diseases. We related diagnosis of UTIs based on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) and in-hospital mortality (IHM) in a cohort of hospitalized elderly subjects. METHODS All patients admitted between 2000 and 2013 to the general hospital of Ferrara, in northeast Italy, with ICD-9-CM code of UTIs were included. IHM was the main outcome, and age, sex, type of microorganism, sepsis, and Charlson comorbidity index (CCI) based on ICD-9-CM, were also analyzed. RESULTS The total sample included 2,266 patients (1,670 women, 73.7%) with UTIs and identification of a cultural organism. Mean age was 81.7±7.5 years (range, 65-103). One hundred and sixteen (5.1%, of whom 34.5% were male and 65.5% were female) cases developed sepsis, and 84 (3.7%, of whom 45.2% were male, 54.8% were female) had a fatal outcome. Nonsurvivors had lower prevalence of IVUs due to Escherichia coli (53.6 vs. 71.7%, p<0.001) and higher prevalence of UTIs due to Pseudomonas aeruginosa (19 vs 7.1%, p<0.001). Moreover, non-survivors developed more frequently sepsis (31% vs. 4.1%, p<0.001), and had higher CCI (2.81±2.43 vs. 2.21±2.04, p=0.011). IHM was independently associated, in decreasing order of odds ratios (ORs), with sepsis (OR 10.3; 95% confidence interval [95% CI] 6.113-17.460, p<0.001), P. aeruginosa infection (OR 2.541; 95% CI 1.422-4.543, p=0.002), female gender (OR 2.324; 95% CI 1.480-3.650, p<0.001), CCI (OR 1.103; 95% CI 1.005-1.210, p=0.038), age (OR 1.034; 95% CI 1.002-1.066, p=0.036), and E. coli infection (OR 0.5; 95% CI 0.320-0.780, p=0.002). CONCLUSIONS In a large sample of elderly patients hospitalized for UTIs in a single center in northeastern Italy, apart the development of sepsis, IHM was much more dependent on pathogen and female gender than comorbidity index and age.
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Affiliation(s)
- Fabio Fabbian
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Alfredo De Giorgi
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Pablo Jesús López-Soto
- 2 Department of Nursing, Maimonides Institute for Biomedical Research in Córdoba, University of Córdoba , Córdoba, Spain
| | - Marco Pala
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Ruana Tiseo
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Rosario Cultrera
- 3 Infectious Diseases Unit, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
| | - Massimo Gallerani
- 4 First Internal Medicine, Department of Medicine, Azienda Ospedaliera-Universitaria , Ferrara, Italy
| | - Roberto Manfredini
- 1 Clinica Medica, Department of Medicine, Azienda Ospedaliera-Universitaria and School of Medicine , Ferrara, Italy
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Pezzi M, Cultrera R, Chicca M, Leis M. Scanning Electron Microscopy Investigations of Third-Instar Larva of Cordylobia rodhaini (Diptera: Calliphoridae), an Agent of Furuncular Myiasis. J Med Entomol 2015; 52:368-374. [PMID: 26334810 DOI: 10.1093/jme/tjv022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/29/2015] [Indexed: 06/05/2023]
Abstract
A scanning electron microscopy study of the third larval instar of Cordylobia rodhaini Gedoelst (Diptera: Calliphoridae), causing obligatory furuncular myiasis, is presented here for the first time. The larvae were collected from a patient exposed to them in the tropical rainforest of Kibale National Park (Uganda). Distinctive features are described in sequence from the anterior region to the posterior region, highlighting the morphological features of antennae, maxillary palps, structures related to mouth opening, sensory structures, thoracic and abdominal spines, and anterior and posterior spiracles. The results are compared with those of other Calyptrata flies, mainly from the family Calliphoridae and, when possible, with Cordylobia anthropophaga Blanchard (Diptera: Calliphoridae), the only other species of genus Cordylobia investigated by scanning electron microscopy.
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Affiliation(s)
- M Pezzi
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - R Cultrera
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M Chicca
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - M Leis
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy.
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Pezzi M, Cultrera R, Chicca M, Leis M. Furuncular Myiasis Caused by Cordylobia rodhaini (Diptera: Calliphoridae): A Case Report and a Literature Review. J Med Entomol 2015; 52:151-155. [PMID: 26336299 DOI: 10.1093/jme/tju027] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/02/2014] [Indexed: 06/05/2023]
Abstract
Some African flies may cause myiasis not only in animals but also in humans, representing a serious health problem for the local population and for tourists. We report a rare case of furuncular myiasis due to larvae of Lund's fly Cordylobia rodhaini Gedoelst (Diptera: Calliphoridae), a species which usually parasitizes small mammals. The myiasis was diagnosed in Italy in a tourist guide who travelled in Central African rainforests of Uganda. The clinical case and the morphological criteria used for species identification are described here, together with a review of all literature cases of human furuncular myiasis due to C. rodhaini.
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Affiliation(s)
- M Pezzi
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - R Cultrera
- Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Via Fossato di Mortara 64/B, 44121, Ferrara, Italy
| | - M Chicca
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy
| | - M Leis
- Department of Life Sciences and Biotechnology, University of Ferrara, Via Luigi Borsari 46, 44121, Ferrara, Italy. Corresponding author,
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Contini C, Badia L, Cultrera R, Grilli A, De Togni A. Epidemiological, clinical and laboratory features of chronic hepatitis B infection in a cohort of immigrant and Italian patients from Ferrara, Italy. Ann Hepatol 2013; 11:862-9. [PMID: 23109449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Italy has recently become a land of immigration. Two hundred and fifty thousand carriers are immigrants and chronic HBV infection is the prevalent form. Considering the elevated number of foreigners resident in our province and the potential risk of transmission to local people, we retrospectively investigated the patterns of chronic hepatitis B (CHB) in 154 patients (76 foreigners, 78 Italians) observed in our Institution, with regard to demographic and clinical/laboratory characteristics. RESULTS The immigrants were younger (mean age 31 years) compared to Italians (51.5) and mainly came from East Europe. Regarding exposure to HBV, the intra-familial risk factor was most frequently observed in foreigners, compared to Italians (p = 0.03). Foreigners also showed a higher prevalence of HBeAg positive forms, HDV co-infection (7.9%) and abnormal ALT and/or HBV-DNA values, compared to Italians. HBeAg positivity was more associated with increased ALT (OR = 36.6, p = 0.001) than with elevated HBV viremia (OR = 6.5, p = 0.049); age was a protective factor (OR = 0.1; p = 0.014). No significant association was found between increased ALT and foreign nationality. The simultaneous presence of increased ALT and viremia was more frequent among foreigners, (OR = 7.6, p = 0,014) and increased with age (OR = 1.06, p = 0.013). Antiviral therapy was given in 7.8% of foreign citizens. CONCLUSION Immigrants constitute a vulnerable population subgroup that would benefit from a more active approach regarding doctor patient relationship for early recognition of HBV and treatment programmes.
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Affiliation(s)
- Carlo Contini
- Department of Clinical and Experimental Medicine, Section of Infectious Diseases, University of Ferrara, Italy.
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Contini C, Seraceni S, Carradori S, Cultrera R, Perri P, Lanza F. Identification of Chlamydia trachomatis in a patient with ocular lymphoma. Am J Hematol 2009; 84:597-9. [PMID: 19650142 DOI: 10.1002/ajh.21477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Accumulating evidence suggests that infectious agents may play a role in ocular adnexa lymphomas (OALs) of MALT-type [1-4]. In particular, Chlamydia psittaci, the causative agent of psittacosis, has been detected by PCR in most patients from Italy or isolated eastern Asiatic countries with OALs in absence of other Chlamydia species [4-8]. These patients have also been shown to have a complete or partial response to doxycycline, recognized to be a cheap and safe treatment in these patients [5,6]. In contrast, OAL patients from other geographic areas and with different genetic background were found to be negative for C. psittaci DNA or had a quite variable response to antibiotic treatment, assuming that this pathogen might not play a ubiquitous role in OALs and that bacterial infection is not associated with OAL [8-12].
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Contini C, Seraceni S, Cultrera R, Castellazzi M, Granieri E, Fainardi E. Molecular detection of Parachlamydia-like organisms in cerebrospinal fluid of patients with multiple sclerosis. Mult Scler 2008; 14:564-6. [PMID: 18562511 DOI: 10.1177/1352458507085796] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The presence of Chlamydia-like organism DNA was investigated by polymerase chain reaction (PCR) in cerebrospinal fluid (CSF) samples from 27 patients previously found positive for Chlamydia pneumoniae DNA: 12 with multiple sclerosis (MS), grouped according to clinical and magnetic resonance imaging (MRI) evidence of disease activity, 8 with other inflammatory neurological disorders and 7 with non-inflammatory neurological disorders. PCR evidence of Chlamydia-like organisms in CSF was observed only in two relapsing-remitting MS patients with clinical and MRI disease activity. These findings suggest a possible association between C. pneumoniae and Chlamydia-like organism brain infections as a cofactor in MS development.
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Affiliation(s)
- C Contini
- Section of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy.
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Minichello VMC, Segala D, Badia L, Cultrera R, Grilli A, Massari L, Contini C. Diagnostic and therapeutic aspects in patients with chronic osteomyelitis and prosthetic infections. Microbiol Med 2008. [DOI: 10.4081/mm.2008.2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Contini C, Segala D, Cultrera R, Minichello VMC. Detection of parvovirus B19 and Chlamydophila pneumoniae in a patient with atypical sarcoidosis. Infection 2007; 37:52-5. [PMID: 17906838 DOI: 10.1007/s15010-007-6313-7] [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: 11/04/2006] [Accepted: 06/11/2007] [Indexed: 11/24/2022]
Abstract
We present an elderly female patient with fever, aplastic anemia, arthralgic symptoms and atypical pneumonia. Serological and clinical findings suggested Parvovirus B19 and Chlamydophila pneumoniae infection. These supposed infections delayed the recognition of underlying sarcoidosis which definitive diagnosis was reached through a lung biopsy and histological demonstration of nonnecrotizing granulomas containing giant cells and noncaseating epithelioid cells. The present case highlights the potential difficulty to diagnose sarcoidosis in the presence of unusual infections which may complicate the course of this disease.
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Affiliation(s)
- C Contini
- Department of Clinical and Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100, Ferrara, Italy.
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Cultrera R, Minichello VMC, Badia L, Coen M, Mascoli F, Contini C. Elevata espressione di hsp-60 di Chlamydophila pneumoniae su placche aterosclerotiche carotidee a prognosi infausta. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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36
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Giuliodori M, Seraceni S, Biondin V, Cultrera R, Contini C. Isolamento colturale e molecolare di Chlamydophila pneumoniae da pazienti con artropatie. Prospettive patogenetiche e diagnostiche. Microbiol Med 2007. [DOI: 10.4081/mm.2007.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cultrera R, Crapanzano Minichello V, Seraceni S, Coen M, Mascoli F, Contini C. P1737 Identification of Chlamydophila pneumoniae heat shock protein 60 on atherosclerotic carotid plaque by RT-PCR. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71576-5] [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: 11/16/2022]
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Cultrera R, Seraceni S, Germani R, Contini C. Molecular evidence of Ureaplasma urealyticum and Ureaplasma parvum colonization in preterm infants during respiratory distress syndrome. BMC Infect Dis 2006; 6:166. [PMID: 17118199 PMCID: PMC1679810 DOI: 10.1186/1471-2334-6-166] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Accepted: 11/21/2006] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ureaplasma urealyticum and U. parvum have been associated with respiratory diseases in premature newborns, but their role in the pathogenesis of the respiratory distress syndrome (RDS) is unclear. The aim of this study was to detect, using molecular techniques, the role of Mycoplasma spp. and Ureaplasma spp. in respiratory secretion and blood specimens of preterm newborns with or without RDS and to evaluate the prevalence of perinatal U. urealyticum or U. parvum infection. The influence of chemotherapy on the clinical course was also evaluated. METHODS Tracheal aspirate or nasopharingeal fluid samples from 50 preterm babies with (24) or without RDS (26) were analysed for detection of U. urealyticum and U. parvum by culture identification assay and PCR. Sequencing analysis of amplicons allowed us to verify the specificity of methods. Clarithromycin (10 mg kg-1 twice a day) was administered in ureaplasma-positive patients who presented clinical signs of RDS. RESULTS 15/24 neonates with RDS (p < 0.001) and 4/26 without RDS were found PCR-positive for U. urealyticum or U. parvum. Culture identification assay was positive in 5/50 newborns, three of which with RDS. Sequencing analyses confirmed the specificity of these methods. Association of patent ductus arteriosus with ureaplasma colonization was more statistically significant (p = 0.0004) in patients with RDS than in those without RDS. CONCLUSION Colonization of the lower respiratory tract by Ureaplasma spp. and particularly by U. parvum in preterm newborns was related to RDS. The routine use of molecular methods could be useful to screen candidate babies for etiologic therapy.
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MESH Headings
- DNA, Bacterial/analysis
- DNA, Bacterial/blood
- Female
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/microbiology
- Infant, Very Low Birth Weight
- Male
- Molecular Sequence Data
- Nasopharynx/microbiology
- Polymerase Chain Reaction
- RNA, Ribosomal, 16S/genetics
- Respiratory Distress Syndrome, Newborn/microbiology
- Sequence Analysis, DNA
- Trachea/microbiology
- Ureaplasma/classification
- Ureaplasma/genetics
- Ureaplasma/isolation & purification
- Ureaplasma Infections/microbiology
- Ureaplasma urealyticum/classification
- Ureaplasma urealyticum/genetics
- Ureaplasma urealyticum/isolation & purification
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Affiliation(s)
- Rosario Cultrera
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Silva Seraceni
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Rossella Germani
- Pediatric and Neonatal Pathology Unit, "G. Salvini" Hospital, Corso Europa, Rho, Milan, Italy
| | - Carlo Contini
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Abstract
Simian virus 40 (SV40) DNA sequences were found, by PCR analysis followed by filter hybridization, in the cerebrospinal fluid of a 29-y-old male affected by AIDS with an undefined cerebral lesion. This case illustrates the need to consider the SV40 polyomavirus among viral agents potentially responsible of encephalitis and neurological disorders in AIDS patients.
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Affiliation(s)
- Fernanda Martini
- Department of Morphology and Embryology, University of Ferrara, Ferrara, Italy
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40
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Contini C, Giuliodori M, Cultrera R, Seraceni S. Detection of clinical-stage specific molecular Toxoplasma gondii gene patterns in patients with toxoplasmic lymphadenitis. J Med Microbiol 2006; 55:771-774. [PMID: 16687598 DOI: 10.1099/jmm.0.46482-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Three cases of symptomatic toxoplasmic lymphadenitis, together with a serologic profile of recent infection, are described, for which quantitative real-time PCR (LightCycler PCR) targeting different parasite genes was designed, in order to quantify Toxoplasma gondii DNA in acute and follow-up blood specimens. Similar parasite gene kinetics and DNA concentrations were observed in the patients studied. However, the profile of each target gene investigated was different. While the level of B1 DNA remained elevated for the entire time of observation, irrespective of clinical and serologic resolution, the SAG-1 gene was detected at the end of acute symptomatic disease, overlapping with a strong anti-T. gondii IgA antibody response, and persisting for over 3 months after infection and clinical recovery. With respect to the two bradyzoite genes investigated (SAG-4 and MAG-1), levels peaked during the symptomatic phase, but did not fall until 2 or 3 months of follow up. The real-time PCR assay with new alternative targets to the B1 gene may have potential for monitoring the clinical outcome of disease and for providing molecular information regarding the actual state of infection.
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Affiliation(s)
- Carlo Contini
- Section of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, Italy
| | - Margherita Giuliodori
- Section of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, Italy
| | - Rosario Cultrera
- Section of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, Italy
| | - Silva Seraceni
- Section of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, Italy
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Contini C, Seraceni S, Giuliodori M, Segala D, Cultrera R, Granieri E. INFEZIONE DEL SISTEMA NERVOSO CENTRALE DA CHLAMYDIA PNEUMONIAE. POSSIBILE RUOLO ETIOPATOGENETICO NELLA SCLEROSI MULTIPLA. Microbiol Med 2005. [DOI: 10.4081/mm.2005.3463] [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: 11/22/2022] Open
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42
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Cultrera R, Giuliodori M, Granchi D, Seraceni S, Contini C. IDENTIFICAZIONE E QUANTIFICAZIONE MOLECOLARE DI UREAPLASMA SPP. SU SECREZIONI RESPIRATORIE DI NEONATI PREMATURI CON RDS. RISULTATI PRELIMINARI. Microbiol Med 2005. [DOI: 10.4081/mm.2005.3510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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43
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Contini C, Seraceni S, Cultrera R, Incorvaia C, Sebastiani A, Picot S. Evaluation of a Real-time PCR-based assay using the lightcycler system for detection of Toxoplasma gondii bradyzoite genes in blood specimens from patients with toxoplasmic retinochoroiditis. Int J Parasitol 2005; 35:275-83. [PMID: 15722079 DOI: 10.1016/j.ijpara.2004.11.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Revised: 11/25/2004] [Accepted: 11/25/2004] [Indexed: 10/26/2022]
Abstract
PCR based methods have advantages over traditional methods for the diagnosis of toxoplasmosis, especially when serology fails and clinical symptoms are not evident. However, current PCR-based assays are often labour-intensive and not readily quantifiable and have the potential for contamination due to a requirement for postamplification sample handling. Real-time PCR can address these limitations. We have developed and evaluated a highly sensitive Real-time PCR (Light-cycler, LC-PCR) to detect and quantify Toxoplasma gondii B1 and bradyzoite specific genes (SAG-4, MAG-1) in serum and peripheral blood mononuclear cells (PBMC) specimens, from five immunocompetent subjects with clinically suspected toxoplasmic retinochoroiditis (TRC) or without a suspected T. gondii infection. A standard curve for quantitation of parasitic load was generated using SYBR Green I fluorescent detection. The results were compared with those obtained with a nested PCR (n-PCR). In TRC patients, both PCR methods confirmed ophtalmoscopy and fluorangiographic findings. Among the TRC patients, the use of LC-PCR was more sensitive than n-PCR for detection and quantification of either B1 gene (P<0.001) or SAG-4/MAG-1 gene (P<0.05). LC-PCR has been shown particularly useful to accurately determine the parasite DNA load in follow-up specimens in whom the performance of either B1 or SAG-4 and MAG-1 in detecting T. gondii loads, varied with respect to specific antitoxoplasmic treatment.
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Affiliation(s)
- Carlo Contini
- Section of Infectious Diseases, Department Clinical and Experimental Medicine, via Fossato di Mortara, 23, 44100 Ferrara, Italy.
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Seraceni S, Eudes N, Peyron F, Giuliodori M, Marchetti D, Cultrera R, Contini C. QUANTIFICAZIONE MEDIANTE REAL-TIME PCR DI GENI DI TOXOPLASMA GONDII IN PAZIENTI AIDS CON ENCEFALITE TOXOPLASMICA (ET) RIATTIVATA. Microbiol Med 2004. [DOI: 10.4081/mm.2004.3769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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45
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Fainardi E, Castellazzi M, Casetta I, Cultrera R, Vaghi L, Granieri E, Contini C. Intrathecal production of Chlamydia pneumoniae-specific high-affinity antibodies is significantly associated to a subset of multiple sclerosis patients with progressive forms. J Neurol Sci 2004; 217:181-8. [PMID: 14706222 DOI: 10.1016/j.jns.2003.09.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 11/19/2022]
Abstract
The purpose of this study was to provide further insight into the effective relevance of the association between Chlamydia pneumoniae and MS. We evaluated by ELISA technique cerebrospinal fluid (CSF) and serum levels of anti-C. pneumoniae IgG in 46 relapsing-remitting (RR), 14 secondary progressive (SP) and 11 primary progressive (PP) MS patients grouped according to clinical and Magnetic Resonance Imaging (MRI) evidence of disease activity. Fifty-one patients with other inflammatory neurological disorders (OIND) and 52 with non-inflammatory neurological disorders (NIND) were used as controls. A C. pneumoniae-specific intrathecal IgG synthesis as detected by the relative specific index was present in a small proportion of MS (17%), OIND (22%) and NIND (2%) patients and was significantly more frequent in MS and in OIND than in NIND (p<0.001) and in SP and PP MS than in RR MS patients (p<0.02). Among the patients with C. pneumoniae-specific intratecally produced antibodies, CSF high-affinity anti-C. pneumoniae IgG were found in the majority of SP or PP MS, occasionally in OIND, but not in RR MS and NIND patients. These findings confirm that the presence of a humoral immune response to C. pneumoniae within the central nervous system (CNS) is not selectively restricted to MS, but is shared by several inflammatory neurological conditions. In addition, our results suggest that an intrathecal production of C. pneumoniae-specific high-affinity IgG can occur in a subset of patients with MS progressive forms in which a C. pneumoniae brain chronic persistent infection may play an important pathogenetic role.
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Affiliation(s)
- Enrico Fainardi
- Multiple Sclerosis Center, Department of Neurology, University of Ferrara, Arcispedale S. Anna, Corso della Giovecca 203, I-44100, Ferrara, Italy.
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Contini C, Fainardi E, Seraceni S, Granieri E, Castellazzi M, Cultrera R. Molecular identification and antibody testing of Chlamydophila pneumoniae in a subgroup of patients with HIV-associated dementia complex. Preliminary results. J Neuroimmunol 2003; 136:172-7. [PMID: 12620657 DOI: 10.1016/s0165-5728(02)00469-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 10/27/2022]
Abstract
Chlamydophila pneumoniae DNA was investigated by polymerase chain reaction (PCR), in cerebrospinal fluid (CSF) specimens from patients suffering from HIV-1-associated dementia complex (HADC). Four (17.3%) cases of C. pneumoniae infection were identified among 23 HADC individuals with DNA amplification of major outer membrane protein (MOMP) gene and 16S rRNA gene sequences. Sequence analysis revealed significant homologies with C. pneumoniae compared to Chlamydia trachomatis and Chlamydia psittaci. High mean levels of CSF specific anti-C. pneumoniae antibodies and C. pneumoniae antibody specific index values significantly elevated were also found by enzyme-linked immunosorbent assay (ELISA) in these patients. The results suggest a hypothetical role of C. pneumoniae in the pathogenesis or progression of HADC.
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Affiliation(s)
- Carlo Contini
- Section of Infectious Diseases, Department of Clinical and Experimental Medicine, via Fossato di Mortara, 23, University of Ferrara, Italy.
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47
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Cultrera R, Seraceni S, Segala D, Contini C. Expression of toxoplasmic 65 kDa cystic mRNA by RT-PCR in patients with Toxoplasma gondii infection relapses. J Eukaryot Microbiol 2002; Suppl:193S-194S. [PMID: 11906059 DOI: 10.1111/j.1550-7408.2001.tb00515.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- R Cultrera
- Department of Clinical & Experimental Medicine, Infectious Diseases, University of Ferrara, Italy.
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48
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Contini C, Seraceni S, Misurati E, Grilli A, Romani R, Cultrera R. A multiplex PCR assay for molecular recognition of T. gondii stage-specific genes. J Eukaryot Microbiol 2002; Suppl:191S-192S. [PMID: 11906058 DOI: 10.1111/j.1550-7408.2001.tb00514.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C Contini
- Department of Clinical & Experimental Medicine, Infectious Disease, University of Ferrara, Italy.
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49
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Contini C, Cultrera R, Seraceni S, Segala D, Romani R, Fainardi E, Cinque P, Lazzarin A, Delia S. The role of stage-specific oligonucleotide primers in providing effective laboratory support for the molecular diagnosis of reactivated Toxoplasma gondii encephalitis in patients with AIDS. J Med Microbiol 2002; 51:879-890. [PMID: 12435069 DOI: 10.1099/0022-1317-51-10-879] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [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: 11/18/2022] Open
Abstract
The switch from bradyzoites to tachyzoites is the fundamental pathogenic event that leads to Toxoplasma gondii encephalitis (TE) in patients with AIDS. Distinction between these stages is difficult, particularly when specific treatment has been started. A new approach consisting of a nested PCR (n-PCR) assay was performed on cerebrospinal fluid (CSF) specimens collected from AIDS patients with TE before or after antiparasitic therapy was initiated, to assess the efficacy of primer sets which amplify target sequences expressed on bradyzoites (SAG4 and MAG1), tachyzoites (SAG1) or both stages (B1) of T. gondii. CSF specimens were obtained from 46 patients with AIDS, of whom 27 had TE (16 first episode, 11 relapse) and 19 had other AIDS-related brain lesions (AIDS-OBL) in the absence of TE. CSF specimens from 26 HIV-negative and immunocompetent patients were also checked. All samples were tested with different primer pairs targeting the B1, SAG-1, SAG-4 and MAG-1 genes. With B1, 75% of patients with first episodes of TE were positive, compared with 36.3% of those with relapse of TE and 5.2% of those with AIDS-OLB. The SAG1 gene yielded positive values in 28.7% and 45.4% of patients with first episodes of TE or relapse of TE, respectively, and in none of the controls. With the SAG4 and MAG1 genes, 72.7% of patients with relapse of TE were detected, compared with 25% of patients with first episodes of TE and 5.2% with AIDS-OLB. None of the HIV-negative subjects showed positive PCR reactions. These results demonstrate that specific primers for the genes SAG4, MAG1 and SAG1 may be useful in AIDS patients with relapse of TE, in whom the use of PCR targeting the B1 gene may fail to detect DNA, especially when prophylaxis or treatment has been started.
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Affiliation(s)
| | | | | | | | - Roberto Romani
- Section of Infectious Diseases, Department of Clinical & Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, *Department of Infectious and Tropical Diseases, ''La Sapienza'' University, Policlinico Umberto 1°, via Regina Elena 331, 00161 Rome, †Division of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127 Milano and ‡Section of Neurologic Clinic, University of Ferrara, Arcispedale S. Anna, C.so Giovecca 203, Ferrara, Italy
| | - Enrico Fainardi
- Section of Infectious Diseases, Department of Clinical & Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, *Department of Infectious and Tropical Diseases, ''La Sapienza'' University, Policlinico Umberto 1°, via Regina Elena 331, 00161 Rome, †Division of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127 Milano and ‡Section of Neurologic Clinic, University of Ferrara, Arcispedale S. Anna, C.so Giovecca 203, Ferrara, Italy
| | - Paola Cinque
- Section of Infectious Diseases, Department of Clinical & Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, *Department of Infectious and Tropical Diseases, ''La Sapienza'' University, Policlinico Umberto 1°, via Regina Elena 331, 00161 Rome, †Division of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127 Milano and ‡Section of Neurologic Clinic, University of Ferrara, Arcispedale S. Anna, C.so Giovecca 203, Ferrara, Italy
| | - Adriano Lazzarin
- Section of Infectious Diseases, Department of Clinical & Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, *Department of Infectious and Tropical Diseases, ''La Sapienza'' University, Policlinico Umberto 1°, via Regina Elena 331, 00161 Rome, †Division of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127 Milano and ‡Section of Neurologic Clinic, University of Ferrara, Arcispedale S. Anna, C.so Giovecca 203, Ferrara, Italy
| | - Salvatore Delia
- Section of Infectious Diseases, Department of Clinical & Experimental Medicine, University of Ferrara, via Fossato di Mortara 23, 44100 Ferrara, *Department of Infectious and Tropical Diseases, ''La Sapienza'' University, Policlinico Umberto 1°, via Regina Elena 331, 00161 Rome, †Division of Infectious Diseases, San Raffaele Hospital, Via Stamira d'Ancona, 20, 20127 Milano and ‡Section of Neurologic Clinic, University of Ferrara, Arcispedale S. Anna, C.so Giovecca 203, Ferrara, Italy
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Cultrera R, Seraceni S, Contini C. Efficacy of a novel reverse transcriptase-polymerase chain reaction (RT-PCR) for detecting Toxoplasma gondii bradyzoite gene expression in human clinical specimens. Mol Cell Probes 2002; 16:31-9. [PMID: 12005445 DOI: 10.1006/mcpr.2001.0394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [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: 11/22/2022]
Abstract
A reverse transcriptase-polymerase chain reaction (RT-PCR) assay, was performed to evaluate the transcription degree of bradyzoite- or tachyzoite-specific genes of Toxoplasma gondii on cerebrospinal fluid (CSF) specimens from AIDS patients with toxoplasmic encephalitis (TE), and to distinguish an asymptomatic latent infection from a reactivated disease. This method was compared with nested DNA amplification (n)-PCR. The mRNA expression of the representative T. gondii cystic matrix (MAG1) or bradyzoite-specific (SAG4) genes was investigated on CSF obtained from AIDS patients with first episode (no. 11) or relapse (no. 8) of TE. The mRNA expression of tachyzoite-specific (SAG1) gene was also studied. New designed oligonucleotide primers and probes, which identify a 212 bp fragment inside to the open reading MAG1 sequence, were employed in both RT-PCR and n-PCR assays. Oligo-dT primed cDNA synthesis appeared a suitable method for subsequent analysis by n-PCR. RT-PCR has been shown to be more sensitive and specific than n-PCR. MAG1 and SAG4 gene expression was detected in 8 (100%) and 6 (75%) patients with TE relapses, respectively, while SAG1 detected 7 (63%) patients with TE first episode. These findings suggest that RT-PCR method is able to identify the bradyzoite stage of T. gondii especially in patients who are at risk for TE relapse.
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Affiliation(s)
- R Cultrera
- Infectious Diseases, Department of Clinical and Experimental Medicine, University of Ferrara, Italy.
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