[Observations about the treatment of Cytomegalovirus retinitis in patients with HIV infection using Ganciclovir and Foscarnet]

Objective: The Authors report their experience of Cytomegalovirus (CMV) retinitis therapy in HIV patients, using Ganciclovir and Foscarnet in monotherapy. They also evaluate the reliability of the Polymerase Chain Reaction (PCR) through the qualitative technique as an index of active disease. Methods: 18 patients suffering from CMV retinitis were treated: Ganciclovir was administered at a dosage of 10 mg/kg b.w./day and Foscarnet at 180 mg/kg b.w./day, both of them for 21 days during the induction phase. During the mantainance phase the former was administered at 5 mg/kg b.w./day and the latter at 90 mg/kg b.w./day for 5 days a week. Results: Both the drugs induced the stabilization or regression of the lesions. There was however a relapse with both therapies. We did not observe a significant difference either in the entity and the duration of the stabilization or in the survival from diagnosis time. Finally the PCR method was not helpful in the diagnosis of CMV retinitis.

[Prevalence of Toxocara spp in public playgrounds in a town of Central Italy]

In this study, the prevalence of Toxocara spp. was evaluated in the soil of 22 public playgrounds of Ancona (Italy). The public playgrounds were selected according to the different areal distribution (centre, low-lying areas centre, hilly areas suburbs) within the urban area of Ancona, central Italy. In six playgrounds there were signs restricting access for dogs; all of them were frequented by children. Parasites were found in the soil samples from 21 out of 22 playgrounds (95.5%). The most prevalent helminth found was Toxocara canis, the common roundworm of dogs. It was detected in the soil samples from 12 (54.5%) playgrounds. This study showed a low frequency of the other parasites. Our data highlight the need for improved knowledge of the relationship between humans and stray animals. Indeed several zooparasites have a role in the etiopathogenesis of common human diseases. The high environmental contamination frequency found underlines the necessity of prompt preventive public health measures, such as control of stray animals, treatment of infected pets and hygiene education of the population to increase awareness of potential zoonotic hazards.

[Giardiasis: a parasitic disease of continued topicality. Study of prevalence among a selected adult population]

We studied the prevalence of Giardia intestinalis in five patients risk groups including institutionalised psychiatric of elderly subjects, HIV-positive immunocompromised patients, immigrants from developing countries and travellers to tropical countries. Stool specimens of 1319 subjects were studied. Stools were collected in triplicate from each subject. The presence of bacteria, viruses and parasites was evaluated. A direct smear examination from fresh faecal specimens and after concentration with formalin-ethylacetate was performed for parasite examination. Smears were also stained by a modified acid fast method and then examined for the presence of Cryptosporidium spp. and other coccidia. Cryptosporidium parvum and G. intestinalis were also detected by immunofluorescent assay. Contemporaneously a microbiological investigation was performed with standard culture, biochemical techniques and viral detection. Clinical data about each subject were provided by standardised questionnaires. G. intestinalis was detected in the stools of 41 subjects (3.5%). The immigrants (5.5%), the institutionalised psychiatric patients (5.0%) and HIV immunocompromised patients (4.6%) showed the highest prevalence. By contrast, travellers showed the lowest prevalence (2.5%). G. intestinalis was the pathogen most frequently detected. The cohorts with the presence of more risk factors showed the highest prevalence. The low prevalence of the parasite among travellers demonstrated the significance of health education before travelling and of the most important role of bacterial etiopathogenesis in "traveller's diarrhoea". Epidemiologically, G. intestinalis remains a protozoon of evident importance and is significantly present in Italy.

Short-term adverse effects from and discontinuation of antiretroviral post-exposure prophylaxis

OBJECTIVE

To evaluate short-term toxicity from and discontinuation of antiretroviral combination prophylaxis in HIV-exposed individuals in Italy.

DESIGN

Longitudinal, open study conducted by prospective collection of data in the National Registry of PEP.

SETTING

All the Italian centres dedicated to HIV related care and licensed by the Ministry of Health to dispense antiretroviral drugs.

STUDY POPULATION

Health care workers and other persons consenting to be treated with post exposure prophylaxis (PEP) after exposures to HIV.

RESULTS

Until October, 2000, 207 individuals receiving two nucleoside reverse transcriptase inhibitors (NRTIs), and 354 receiving two NRTIs plus a protease inhibitor (PI) were enrolled. More individuals experienced side-effects in the 3-drug group (53% and 62%, respectively; OR 0.68, (95% CI 0.48-0.98), p < 0.03). However, the proportion of individuals discontinuing prophylaxis because of side-effects did not differ significantly between the 2 groups (21% and 25% respectively; OR 0.82 (95% CI 0.53-1.26); p=0.4). The 43 individuals in the 2 NRTI group discontinued PEP after a mean of 10.4 days of treatment (median 8, range 1-27), similarly to the 88 discontinuations observed in the 3-drug group (mean duration 10.5 days, median 7.5, range 1-26). Type and incidence of specific adverse effects were similar to those reported in the literature.

CONCLUSION

Our study indicates that the difference in the proportion of individuals developing side effects and discontinuing PEP is not significant. The rate of discontinuation because of protease inhibitor side-effects does not justify per se the initial use of a less potent PEP regimen. We suggest initiating PEP with a three-drug regimen and discontinuing the protease inhibitor in the case of adverse effects.

In vitro activities of membrane-active peptides alone and in combination with clinically used antimicrobial agents against Stenotrophomonas maltophilia

The in vitro activities of buforin II, cecropin P1, and magainin II, alone and in combination with six clinically used antimicrobial agents, against 12 clinical isolates of Stenotrophomonas maltophilia were investigated. Antimicrobial activities were measured by MIC and time-kill studies. The isolates were susceptible to the peptides at concentrations in the range of 0.50 to 16 microg/ml. Synergy was observed when the peptides were combined with polymyxin E, meropenem, ceftazidime, piperacillin, and clarithromycin.

Prevalence and clinical relevance of Blastocystis hominis in diverse patient cohorts

The pathogenicity of Blastocystis hominis is extensively debated in the medical literature. Therefore, we did a prevalence study to investigate the association between the presence of several intestinal parasites and gastrointestinal symptoms in diverse patient cohorts. The study population consisted of 1216 adults, including immunocompromised patients, institutionalized psychiatric or elder subjects, immigrants from developing countries, travellers to developing tropical countries and controls. Several variables for each risk group were considered. Stools specimens, collected in triplicate, were processed by the same technicians. Clinical data about each subject were provided by standardized questionnaires. The presence of gastrointestinal symptoms were related to the presence of any parasite. In addition, on the basis of microbiological results, five subgroups of subjects were evaluated. The results showed a high prevalence of parasites in all the risk groups. Immunocompromised status, recent arrival from developing countries and the presence of behavioural aberrations were significantly related to presence of parasites. B. hominis was the parasite most frequently detected in each studied group. B. hominis showed a significant correlation with gastrointestinal symptoms only when detected in the group including subjects with a severe immunodepression. Immunodepression seems to be a factor of primary importance of the pathogenic role of B. hominis.

Cyclosporiasis in a traveler returning from South America

Cyclospora is a coccidian, previously referred to as a cyanobacterium-like body, with an epidemiology similar to that of Cryptosporidium parvum. In recent years, several studies have shown that Cyclospora is not a rare opportunistic pathogen but rather is the cause of common, worldwide intestinal infections in healthy adults and children. Previous reports of diarrhea resulting from Cyclospora sp. have been linked to travelers and immunocompromised patients. The species has a worldwide distribution. Although Cyclospora infection has been reported from Southeast Asia, Papua New Guinea, Indonesia, India, Pakistan, Nepal, the Middle East, North Africa, the United Kingdom, the Caribbean, the United States, Central America, and South America, the true prevalence of this parasite in any population is unknown. The parasite is associated with prolonged self-limiting and relapsing watery diarrhea, anorexia, fatigue, and sometimes myalgia. Fever is infrequent.

Epidemiologic features of intestinal parasitic infections in Italian mental institutions

To determine the prevalence of intestinal parasitic infections in the residents of four Italian psychiatric institutions, we examined the stool specimens collected in triplicate from 238 residents, enrolled between May 1995 and May 1996. Besides, physician and staff nurses provided data about each resident by standardized questionnaires. Parasites were detected in the fecal samples from 128 patients (53.8%). However, in the stool specimens from 106 residents only non-pathogenic protozoa were found (82.8%). Trichuris trichiura ova, Giardia lamblia cysts and trophozoites, Cryptosporidium parvum oocysts, and Balantidium coli cysts were found in the fecal samples from 22 residents (9.2%). B. hominis was the most prevalent parasite. It was detected in the fecal specimens from 97 residents (40.8%). The so-called nonpathogenic amebae were detected in the fecal specimens from 65 residents, though, at the same time, there was no evidence of Entamoeba histolytica infection. Twelve residents (5.0%) showed intestinal colonization by nonpathogenic flagellates. All the subjects with T. trichiura infection were housed in the facility of Ancona. Parasites were found in fecal samples from all the 11 residents with behavioural aberrations, but only three of those suffering from intestinal pathogen infection associated to diarrhea. Statistical analyses revealed that the presence of pathogenic parasites in fecal specimens was significantly associated with diarrhea, nausea, vomiting, abdominal pain, fever, behavioural aberrations and nonpathogenic protozoa (p < 0.01), but did not demonstrate any other significant associations between these parasites and the other variables, such as pruritus, mucus or blood in the stools and presence of fecal leukocytes. On the other hand, the presence of nonpathogenic protozoa was significantly related to aberrations such as pica, geophagia, phytophagy, coprophagy, coprophilia and pathogenic parasites (p < 0.01). Data analyses revealed that both pathogenic and nonpathogenic parasites were significantly more common in institutionalized patients than in controls. The rare presence of clinical signs and symptoms in colonized patients represents an important public health problem, since the presence of asymptomatic carriers among residents with low hygienic conditions, raises concern of transmission of parasitic infections to professional staff and other residents. Since the eradication of parasitic colonization in residential facilities is hard to reach, an effective prevention is the only measure to deal with this public health problem.

Therapy with immunoglobulin of the HIV infection related idiopathic thrombocytopenia

The Authors report that in their experience in the therapy of HIV infection related thrombocytopenia with IG at the classic dose of 0.4 gr/Kg/day x 5 days. Moreover they report their experience in a patient with repeated single-dose infusions at low dosage. They treated four patients, who were drug-addicts, with HIV infection thrombocytopenia that didn't exceed 50,000/mm3. Anti-platelets antibodies tested with an indirect method weren't found in any of the patients examined. Among those patients three were of Group III CDC and one of Group IV C1 CDC. Among the first group the best results were obtained in two patients with the immunocompromission of average seriousness but one of these had a rapid decrease in platelets count. In the others where results were low a severe immunocompromission was apparent and probably a severe damaged Reticulo Endothelial System (RES) function. So the AA think that function of RES may be important in the forecast of clinical response. The Authors conclude moreover that good results were obtained with a single-dose infusion at low dosage even if they observed a progressive decrease of response. They propose such a therapy if there isn't an emergency after tested RES function.