Case report: Persistent strongyloidiasis complicated by recurrent meningitis in an HTLV seropositive Peruvian migrant resettled in Italy

We describe a case of persistent strongyloidiasis complicated by recurrent meningitis, in a human T cell lymphotropic virus type 1 (HTLV-1) seropositive Peruvian migrant adult resettled in Italy. He was admitted with signs and symptoms of acute bacterial meningitis, reporting four other meningitis episodes in the past 6 years, with an etiological diagnosis of Escherichia coli and Enterococcus faecium in two cases. He had been previously treated with several antihelmintic regimens not including ivermectin, without eradication of strongyloidiasis, and he had never been tested for HTLV before. During the described episode, the patient was treated for meningitis with broad-spectrum antibiotic therapy and 200 mg/kg/dose oral ivermectin once daily on day 1, 2, 15 and 16 with full recovery and no further episodes of meningitis. The presented case underlines several critical points concerning the management of poorly known neglected diseases such as strongyloidiasis and HTLV infection in low-endemic areas. Despite several admissions for meningitis and strongyloidiasis, the parasitic infection was not adequately treated and the patient was not previously tested for HTLV. The supply of ivermectin and the choice of treatment scheme was challenging since ivermectin is not approved in Italy and there are no standardized guidelines for the treatment of severe strongyloidiasis in HTLV seropositive subjects

Use of Miltefosine in a Patient With Mucosal Leishmaniasis and HIV-coinfection: A Challenge in Long-Term Management

The management of mucosal leishmaniasis in immunocompromised patients is not standardized and limited data are available on the use of miltefosine for treatment and secondary prophylaxis. We describe a case of mucosal leishmaniasis in an HIV-coinfected patient treated with miltefosine due to a severe allergic reaction to liposomal amphotericin B

Evolution of macrolide resistance in streptococcus pyogenes over 14 years in an area of central Italy

We evaluated temporal fluctuations in macrolide resistance rates, analysing genetic determinants of resistance and clonal evolution in a population of 2744 S. pyogenes isolates collected in the period 2000–2013. The total resistance rate to erythromycin of the isolates was 17.9%. A maximum of erythromycin resistance emerged in 2000 (38.6%), followed by a significant decrease to 5.2% in 2012 (P<0.0001). Molecular analysis revealed the presence and co-presence of known genetic resistance determinants mefA, mefE, ermTR and ermB, in line with phenotypes. PFGE analysis identified genetically related groups in 2000 and 2007–2008, mainly the MLS and M phenotypes, respectively. The most prevalent emm types among a representative subset of resistant isolates were emm2, emm75 and emm77. All emm2 and 88.2% of the strains harbouring the emm75 gene were only recorded in M-phenotype strains, whilst all emm77-positive strains had the inducible MLS phenotype. The analysed susceptible isolates showed several emm types partially shared with resistant ones. Our results suggest that changes in bacterial population clonality, rather than horizontal transfer of resistance determinants, plays a major epidemiological role in S. pyogenes. Continuous monitoring of microbiological epidemiology seems to be crucial for correct and effective management of streptococcal infections

Prevalence of M75 Streptococcus Pyogenes strains harboring slaa gene in patients affected by pediatric obstructive sleep apnea syndrome in Central Italy

Recently we reported an association between pediatric obstructive sleep apnea syndrome (OSAS) and Group A streptococcus (GAS) sub-acute chronic tonsil colonization. We showed that GAS may contribute to tonsil hyperplasia via a streptolysin O (SLO)-dependent cysteinyl leukotrienes (CysLTs) production, which can trigger T and B cell proliferation. In the present study, we characterized the GAS strains isolated from pediatric OSAS patients in comparison with a panel of age and sex matched GAS strains unrelated to OSAS, but isolated in the same area and during the same period ranging from 2009 to 2013. We found that slaA gene, previously reported to be associated to CysLTs production pathway, was significantly associated to GAS OSAS strains. Moreover, the most numerous group (32%) of the GAS OSAS strains belonged to M75 type, and 6 out of 7 of these strains harbored the slaA gene. Multilocus Sequence Typing (MLST) experiments demonstrated that the clone emm75/ST49/ smeZ, slaA was associated to OSAS cases. In conclusion, we found an association between slaA gene and the GAS OSAS strains, and we showed that the clone emm75/ST49 harboring genes smeZ and slaA was exclusively isolated from patients affected by OSAS, thus suggesting that this genotype might be associated to the pathogenesis of OSAS, although further studies are needed to elucidate the possible role of SlaA in tonsil hypertrophy development

Paediatric obstructive sleep apnoea syndrome (OSAS) is associated with tonsil colonisation by Streptococcus pyogenes

The involvement of pathogenic bacteria in obstructive sleep apnoea syndrome (OSAS) has yet to be elucidated. We investigated the possible role of group A streptococcus (GAS) in OSAS pathogenesis. In 40 tonsillectomized patients affected by OSAS and 80 healthy controls, significant (p < 0.0001) association of GAS with paediatric OSAS was found. Supernatant from streptolysin O (SLO)-producing GAS induced production of cysteinyl leukotrienes (CysLTs) in tonsil mononuclear cells (TMCs). CysLTs-treated TMCs showed significant (p < 0.05) proliferation of CD4+ T, CD19+ and CD19+CD27+CD38+ B lymphocytes. We discovered a SLO-dependent activation of CysLTs production through a pathway involving TOLL-like receptor 4 (TLR4), TIR-domain-containing adapter-inducing interferon-β (TRIF), Myeloid differentiation primary response gene 88 (MyD88), and p38 MAP Kinase. In conclusion, we hypothesise that GAS may contribute to paediatric tonsillar hyperplasia through CysLTs production induced by SLO, and this might explain its association with OSA

Valutazione di un test in chemiluminescenza per la diagnosi sierologica di Leishmaniosi Viscerale

Nel bacino del Mediterraneo la Leishmaniosi viscerale (LV) è una zoonosi sostentuta da L. infantum. La diagnosi dipende da caratteristiche del parassita e dell'ospite. Gold standard per la conferma sierologica è l'immunofluorescenza (IFAT). Test di laboratorio completamente automatizzati e applicabili a campioni inviati sporadicamente, potrebbero superare le criticità dell'IFAT. Scopo dello studio è stato quello di valutare nella diagnosi di LV il test in chemiluminescenza “Leishmania VIRCLIA IgG + IgM monotest”(VIRCLIA)(Vircell,Santa Fe, Granada, Spain). Sono stati utilizzati 20 campioni di siero provenienti da pazienti con diagnosi di LV confermata. Ogni campione è stato saggiato con VIRCLIA ed il risultato è stato comparato con le altre indagini microbiologiche disponibili (IFAT, esame microscopico, PCR). I sieri provenienti da pazienti con diagnosi di LV, sono stati selezionati in modo da rappresentare le più frequenti presentazioni della malattia nella nostra area geografica (HIV, trapiantati, immunosoppressione iatrogena, età pediatrica). Come sieri di controllo sono stati utilizzati n.1 campione proveniente da paziente con leishmaniosi cutanea (LC) e n. 18 campioni provenienti da pazienti in accertamento o con diagnosi alternative. Nei 20 campioni da soggetti con LV confermata parassitologicamente, la sierologia IFAT era disponibile per 16 e positiva in 14; VIRCLIA è risultato positivo in 18, equivoco in un caso, negativo in un paziente. VIRCLIA è risultato negativo nel caso di LC. Nei 18 campioni utilizzati come controlli (tutti con sierologia IFAT negativa), VIRCLIA è risultato negativo in 16 ed equivoco in 2. Nella casistica analizzata, costituita da una popolazione clinicamente eterogenea di pazienti con LV, il test VIRCLIA ha mostrato un’ottima performance, confermando sierologicamente tutti i casi ad eccezione di due soggetti ematologici (con sierologia IFAT negativa o al cut-off). La nostra esperienza suggerisce che il test VIRCLIA possa rappresentare una valida alternativa all’IFAT, nel percorso diagnostico integrato di sospetta LV. I valori al cut off dovrebbero essere attentamente valutati in relazione ai dati clinici ed altre metodiche diagnostiche disponibili

Evaluation and Optimization of an ELISA Procedure to Quantify Antibodies Against Pneumococcal Polysaccharides Included in the 13-Valent Conjugate Vaccine

The 13-valent pneumococcal conjugate vaccine (PCV-13) is recommended for HIV-infected people, although its effectiveness in this population remains under evaluation. In this study we describe the development, optimization and analytical validation of an ELISA procedure to measure specific antibodies for the pneumococcal polysaccharide serotypes included in PCV13 vaccine, testing sera obtained from HIV-infected outpatients (n=30) who received the vaccine. The protocol followed the last version of WHO guidelines, based on the new standard 007sp, with the modification of employing Statens Serum Institut (SSI) antigens. We supplied the assay performance validation in terms of sensitivity, reproducibility, precision and accuracy. In addition we detailed optimal antigen-coating concentrations and ELISA conditions common to all 13 serotypes, suitable for laboratories performing these assays in order to standardize the method. Our procedure showed reproducibility and reliability, making it a valid alternative for evaluating the response to pneumococcal serotypes included in PCV13 vaccine