Il paesaggio che cambia

Convegno: Paesaggio Rurale \u2013 Paesaggio Cultural

Molecular and Immunological Characterization of Staphylococcus aureus in Pediatric Atopic Dermatitis: Implications for Prophylaxis and Clinical Management

S. aureus represents a critical cofactor in atopic dermatitis (AD). In this paper, the prevalence of S. aureus infection/colonization was evaluated in 117 children as well as in their cohabitants, in order to assess the value of S. aureus characterization in predicting disease onset and severity and in providing indications for prophylaxis. Results showed that children with AD as well as their cohabitants had a significantly greater incidence of S. aureus infection/colonization as compared to controls. The genetic characterization showed a virtual identity of the bacteria strains collected at different sites of the patients with those found in the cohabitants, suggesting both a direct transmission between the nasal reservoir and the lesions in the same atopic subject and a risk for reinfection within family cohabitants. These data stress the need of preliminary laboratory assessment and posttherapy control in both AD patients and their close contacts for effective S. aureus eradication

Anterior chamber angle imaging with Automatic Gonio-Photography

Abstract Purpose : ssessing the anterior chamber angle (ACA) is essential when evaluating patients with suspected or diagnosed glaucoma. The aim of this study was both to assess inter-observer agreement on Automatic Gonio-Photography (AGP) - true color images of the ACA - and inter-device agreement by comparing AGP to gonioscopy. Methods :prototype AGP device (Gonioscope NGS-1; Nidek Technologies srl) was used to acquire 360-degree images on both eyes of twenty consecutive patients recruited from the glaucoma service at the University Eye Clinic of Genoa (Italy). Two masked observers graded the apparent iris insertion for each of the four quadrants of the ACA and reported ACA abnormalities in AGPs randomly presented. All patients underwent dynamic gonioscopy and the 4 quadrants were graded again using the Spaeth Classification. Inter-observer and inter-device agreement for apparent iris insertion were determined by using Cohen\u2019s linearly weighted \u3ba (KW) coefficient of concordance. Statistical analysis was performed using MedCalc 15.11 (MedCalc Software, Ostend, Belgium). Results : wenty (12.5%) of the 160 quadrants were excluded from statistical analysis because of poor image quality. AGP showed substantial inter-observer agreement (KW, 0.77; 95% CI, 0.67-0.87) with regards to apparent iris insertion. Both observers correctly identified ACA abnormalities, i.e. iridotrabecular contact in two or more quadrants (5), iridectomy (3), internal ostium of the trabeculectomy site (2), EX\u2013PRESS\uae device (1), tube (1), anterior chamber IOL (1), and angle recession (1). All abnormalities were confirmed at gonioscopy. Differentiating between appositional and synechial iridotrabecular contact was only possible with dynamic gonioscopy. Results of AGP and gonioscopy showed almost perfect inter-device agreement on apparent iris insertion evaluation (KW, 0.92; 95% CI, 0.86 to 0.98). Conclusions :P using the NGS-1 gonioscope is a reliable method for assessing apparent iris insertion and proved useful in detecting pathological and postoperative ACA findings in glaucoma patients. This technique also appears to be reliable when recording ACA structures. This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016. Angle recession obtained with AGP

Decompensated Cirrhosis as Presentation of LKM1/LC1 Positive Type 2 Autoimmune Hepatitis in Adulthood. A Rare Clinical Entity of Difficult Management

Background: Autoimmune hepatitis (AIH) is a chronic and aggressive liver disease that rapidly evolves into cirrhosis and end-stage liver disease if not timely diagnosed and treated with immunosuppressive therapy. AIH is classified into type 1 and type 2 according to the autoantibody pattern, with smooth muscle antibodies and/or antinuclear antibodies as serological markers of AIH-1, while antiliver cytosol antibody type 1 and/or antiliver/kidney microsomal antibody type 1 characterize type 2 AIH, which mainly affects children, including infants, and adolescents. Case Summary: We describe a case of type 2 AIH, clinically onset in a 34-year-old woman with decompensated cirrhosis. Only a thorough analysis of the autoantibody profile allowed for a diagnosis of an AIH-2 evolved into cirrhosis. The patient received a moderate corticosteroid therapy without achieving optimal disease control. We discuss the controversial decision of whether or not to treat the patient with immunosuppressive therapy, which should be balanced with the potential risk of infectious and other complications. A review of the literature on the management of patients with autoimmune cirrhosis is also presented. Conclusions: AIH-2 can be clinically onset in adult patients with cirrhosis and its complications, without being preceded by major clinical signs. Due to the difficult management of cirrhosis with immunosuppressive treatments, a patient-tailored strategy with a case-by-case approach is needed to prevent major complications such as infections, potentially precluding liver transplantation the only curative therapy

Case report of disseminated nocardiosis during immunosppressive treatment

Infection caused by Nocardia spp. Is unusual and presents with a variety of clinical manifestations in both immunocompromised patients and in immunocompetent hosts.The diagnosis of Nocardia is often difficult, and further hampered by the absence of specific clinical symptoms.A man, 63 years old, caring for about a month from multiple erosions of the oral cavity and Inca intergluteale associated with blisters and erosions scattered in the face, scalp and trunk.The routine laboratory tests, including serological testing for HIV and the determination of circulating CD4 lymphocytes, were negative.The chest X-ray was also negative. Due to the diagnostic suspicion of Pemphigus vulgaris (PV), therapy with methylprednisolone and azathioprine was initiated. After 15 days the patient’s condition worsened and it became necessary hospitalization in intensive care. A CT scan found: pleural empyema, abscess, and paravertebral muscle abscess. The cultural examination of pleural fluid and synovial fluid gave positive results for Nocardia asteroides. On this basis, sulphamethoxazole was administered in association with trimethoprim for 2 months, with a complete remission of the symptoms.At a median follow up of 2 years the patient’s general condition was excellent, without residual signs of infection.The cultured samples from pleural and synovial fluids gave a clear positivity after 5 days of incubation at 37 ° C on blood agar and chocolate agar plates; the colonies showed chalky and thin filaments, slide as branched Gram-positives and appeared partially acid-alcohol resistant by modified Kinyoun staining (1% H2SO4). The presumptive identification of Nocardia spp. was additionally confirmed by biochemical tests for the identification of species with the following results: catalase test positive, oxidase test negative, aesculin hydrolysis, reduction of nitrite to nitrate and urease test positive. Given the low incidence of Nocardia spp. infection, and the non-typical clinical manifestations, microbiological diagnosis of this infection is critical for the selection of an appropriate antibiotic therapy that should be prolonged for several months

Case report of disseminated nocardiosis during immunosppressive treatment

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