Invasive fungal infections in Neonatal Intensive Care Units of Southern Italy: a multicentre regional active surveillance (AURORA Project)

Introduction. During the past years invasive fungal infections (IFIs) have become an increasingly important problem in infants hospitalized in the Neonatal Intensive Care Unit (NICU). Candida species is the third most-common agent of late-onset infections in critically ill neonates, with an estimated incidence of 2.6-10% in very low birth weight and 5.5-20% in extremely low birth weight infants. The aim of this observational study is to evaluate the epidemiology of IFIs among infants admitted to NICUs of one Italian region by a multicenter surveillance (Aurora Project). Methods. The IFIs surveillance was carried out prospectively in Apulia (Southern Italy) between February 2007 and August 2008. This report focuses on the results from 6 enrolled NICUs. Results. Twenty-one neonates developed IFIs: the overall incidence was 1.3% and crude mortality was 23.8%. Infants weighing ? 1500g (4.3%) showed a significantly higher incidence than those ? 2500g (0.2%). C.parapsilosis (61.9%) was the most frequent isolated species. The main potential risk factors were having a central venous catheter placed, length of stay in NICU > 7 days and total parenteral nutrition for > 5 days. The (1,3)-Ã-D glucan (BDG), mannan antigens and anti-Candida antibodies? evaluation was performed in 7 neonates. All neonates were positive to the BDG; the mannan antigen result was positive in 5 newborns, the anti-mannan antibodies were always negative. All isolates were amphotericin B and fluconazole-susceptible. Discussion. This first prospective study on neonatal fungal infection in one Italian region gives evidence of a preponderance of non-albicans Candida spp and indicates potential utility of BDG as an adjunct diagnostic test

Procalcitonin: a possible marker of invasive fungal infection in high risk patients?

No abstrac

APP1 Transcription Is Regulated by Inositol-phosphorylceramide Synthase 1-Diacylglycerol Pathway and Is Controlled by ATF2 Transcription Factor in Cryptococcus neoformans

Inositol-phosphorylceramide synthase 1 (Ipc1) is a fungal-specific enzyme that regulates the level of two bioactive molecules, phytoceramide and diacylglycerol (DAG). In previous studies, we demonstrated that Ipc1 regulates the expression of the antiphagocytic protein 1 (App1), a novel fungal factor involved in pathogenicity of Cryptococcus neoformans. Here, we investigated the molecular mechanism by which Ipc1 regulates App1. To this end, the APP1 promoter was fused to the firefly luciferase gene in the C. neofor-mans GAL7:IPC1 strain, in which the Ipc1 expression can be modulated, and found that the luciferase activity was indeed regulated when Ipc1 was modulated. Next, using the luciferase reporter assay in both C. neoformans wild-type and GAL7:IPC1 strains, we investigated the role of DAG and sphingolipids in the activation of the APP1 promoter and found that treatment with 1,2-dioctanoylglycerol does increase APP1 transcription, whereas treatment with phytosphingosine or ceramides does not. Two putative consensus sequences were found in the APP1 promoter for ATF and AP-2 transcription factors. Mutagenesis analysis of these sequences revealed that they play a key role in the regulation of APP1 transcription: ATF is an activator, whereas AP-2 in a negative regulator. Finally, we identified a putative Atf2 transcription factor, which is required for APP1 transcription and under the control of Ipc1-DAG pathway. These studies provide novel regulatory mechanisms of the sphingolipid pathway involved in the regulation of gene transcription of C. neoformans

Sequence based typing of Legionella pneumophila sg 1 isolated in nosocomial acquired infections in Apulia, Southern Italy

Objective. The present report aims to molecularly characterize seven clinical L. pneumophila (L. pn.) sg 1 isolated from noso- comial acquired infections in Apulia region, using the European Working Group on Legionella Infections (EWGLI), sequence- based typing (SBT) and amplified fragment length polymorphism (AFLP) protocols and to compare the identified sequence types (STs) with those available in the EWGLI database. Methods. In the period, January 2000 - December 2012, 151 cases (136 of community and 15 of nosocomial origin) of Legion- naires? disease were notified to the Regional Center for Epide- miology. With regard to nosocomial cases, 8 were confirmed by the isolation of Legionella spp. from respiratory secretions. These clinical isolates were characterized by amplified fragment length polymorphism (AFLP) and sequence-based typing (SBT), using the EWGLI standardized protocol. Results. The clinical isolates belong to ST42, ST23 and ST1. The AFLP confirms the SBT results. Comparing the STs herein detected with those already in the EWGLI SBT database, the 3 STs are frequent in other European countries. Conclusions. The molecular analysis demonstrates that the 3 STs are the most frequent in Italy and in Europe, supporting the hypothesis that some specific L. pn. sg 1 clones have gained widespread dissemination probably due to a common ecological niche. Further researches are required to investigate the potential changing incidence of STs and the fitness of emerging strains or clonal groups in environmental strains

Spatial distribution of fungal microflora in the sediment of a brackish lake (Lake Alimini Grande, Italy) used for fish production and bathing

A study of the distribution of fungal microflora was conducted on the sediment of Lake Alimini Grande in order to contrib- ute to the evaluation of the ecosystem characteristics that can effect the process of decomposition. The isolation and identification of fungal species and ergosterol analysis were performed on sediment samples taken from 33 monitorin stations in autumn and winter .Altogether, 24 strains belong- ing to 8 genera were isolated. Trichoderma spp (41.6%) and Aspergillus spp (20.8%) were the dominant genera: in par- ticular, Trichoderma was present near the Traugnano marsh, whereas Aspergillus was isolated in the area of connection to the sea

The Role of Urban Wastewater in the Environmental Transmission of Antimicrobial Resistance: The Current Situation in Italy (2010-2019)

Scientific studies show that urban wastewater treatment plants (UWWTP) are among the main sources of release of antibiotics, antibiotic resistance genes (ARG) and antibiotic-resistant bacteria (ARB) into the environment, representing a risk to human health. This review summarizes selected publications from 1 January 2010 to 31 December 2019, with particular attention to the presence and treatment of ARG and ARB in UWWTPs in Italy. Following a brief introduction, the review is divided into three sections: (i) phenotypic assessment (ARB) and (ii) genotypic assessment (ARG) of resistant microorganisms, and (iii) wastewater treatment processes. Each article was read entirely to extract the year of publication, the geographical area of the UWWTP, the ARB and ARG found, and the type of disinfection treatment used. Among the ARB, we focused on the antibiotic resistance of Escherichia coli, Klebsiella pneumoniae, and Enterococci in UWWTP. The results show that the information presented in the literature to date is not exhaustive; therefore, future scientific studies at the national level are needed to better understand the spread of ARB and ARG, and also to develop new treatment methods to reduce this spread

Caries experience among adolescents in southeast Italy

Abstract Background/purpose According to WHO recommendations, 12-year-olds are considered an important target group for evaluating the level of dental caries among children with permanent teeth, and are often chosen for international comparisons. The aim of the present study was to evaluate the current oral health status of 12-year-old children in southeast Italy, stratified by gender and residential area. Materials and methods The survey was conducted on 431 children enrolled by multistage cluster sampling. A dental caries experience index (decayed, missing, and filled permanent teeth; DMFT) was recorded at schools by a team of examiners trained at the start of the study. Statistical analyses by Chi-square, Fisher's exact, and Wilcoxon tests were performed using SAS version 9.1 software for PCs. We applied the Zero-Inflated Negative Binomial regression model in the STATA package. Results Caries prevalence was recorded in 38.3% of the sample. Estimated means and 95% confidence intervals of the DMFT index by gender were: 1.15 (0.91–1.39) for males, 1.26 (1.02–1.5) for females, and 1.21 (1.03–1.39) for the total sample. The D component of the index was dominant. The mean number of caries found in southeast Italy was significantly higher than the national mean ( t =3.125, P=0.002), but significantly lower than the mean for south Italy ( t =−2.125, P=0.03). Results of the regression model showed that only the mother and father's nationality and educational level contributed to the DMFT. Conclusions The oral health situation of 12-year-old children from southeast Italy seems to be in line with that in other Western European countries

Antibiotic susceptibility of Legionella pneumophila strains isolated from hospital water systems in Southern Italy

The purpose of this study was to describe the susceptibility of environmental strains of Legionella spp. to 10 antimicrobials commonly used for legionellosis therapy. A study of environmental strains could be useful to timely predict the onset of antibiotic resistance in the environment before it is evidenced in clinical specimens

Legionella and legionellosis in touristic-recreational facilities. Influence of climate factors and geostatistical analysis in Southern Italy (2001-2017)

Legionella is the causative agent of Legionnaires' disease, a flu-like illness normally acquired following inhalation or aspiration of contaminated water aerosols. Our recent studies revealed that climatic parameters can increase the number of reported cases of community-acquired Legionnaires' disease. Here, we evaluated the presence of Legionella in water networks and the distribution of Legionnaires' disease cases associated with touristic-recreational facilities in the Apulia region (southern Italy) during the period 2001-2017 using geostatistical and climatic analyses. Geostatistical analysis data revealed that the area with the highest concentration of Legionella in water systems also had the greatest number of cases of Legionnaires' disease associated with touristic-recreational facilities. Climatic analysis showed that higher daily temperature excursion (difference between maximum and minimum temperature) on the day of sampling was more often associated with Legionella-positive samples than Legionella-negative samples. In addition, our data highlighted an increased risk of Legionnaires' disease with increases in precipitation and average temperature and with decreases in daily temperature excursion (difference between maximum and minimum temperature over the course of 24 h in the days of incubation period of disease) and minimum temperature. Healthcare professionals should be aware of this phenomenon and be particularly vigilant for cases of community-acquired pneumonia during such climatic conditions and among the tourist population. The innovative geo-statistical approach used in this study could be applied in other contexts when evaluating the effects of climatic conditions on the incidence of Legionella infections