Bartonellosis: suggestive case reports in adult and pediatric patients and therapeutic issues

Cat-scratch disease warrants extensive investigation, from an epidemiological, a diagnostic, but especially a therapeutic point of view. Two suggestive episodes of Bartonella henselae-caused cat-scratch disease are reported, and discussed in the light of the most recent literature evidence. The first case occurred in a 60-year-old man, thus suggesting that it is important to maintain an elevated level of suspicion for this disease in adults as well. Both episodes were characterized by a very prolonged and complicated disease course (with the involvement of three lymph node sets in the first case), a need for lymph-node drainage, and apparently negligible activity of many antimicrobial courses, with a very slow local cure. While specific culture and molecular biology techniques proved negative (probably due to late availability of appropriate clinical specimens), indirect immunofluorescence antibody assay was positive since the first weeks of disease, and elevated levels were also fond many months after disease onset. When clinicians face patients with prominent swelling of lymph nodes draining from the upper limbs, cat-scratch disease may be suspected on the grounds of epidemiological and clinical features, with a limited systemic involvement contrasting with a prominent local disease. The significance of specific antibody temporal kinetics in the subacute disease course is still unknown. Although biomolecular assays are now available, the time elapsed from disease onset to clinical diagnosis usually hampers diagnosis, while the roles of surgical debridement and of the unpredictable activity of antimicrobial chemotherapy warrant careful investigation

La peste a Bologna nel 1527.

In Italy in the year 1527, following the invasion of lans-quenetes headed by Georg von Frundsberg, a part of the army sent by Charles V to Italy to subjugate the Italian states who adhered to the Cognac leages, the bubonic plague appeared.In Bologna during the year 1527 the believeres held a pro-cession from the Sanctuary of the Madonna del Soccorso, through the city, until the S. Rocco church. The reason of this practice was linked with the plague epidemic. After the discovery of some cases of plague in the Borgo di San Pietro district, the heritage reports the miracle of the inter-ruption of the epidemics, thanks to the intervention of Our Lady.Later, after several decades, some authors from Bologna, who were not witnesses of the facts, reported that the epi-demic had involved 12,000 persons out of an overall popu-lation of around 60,000 people, at that time.We re-evaluated this situation starting from demographic data of the Bologna citizens of the XV, XVI and XVII cen-turies; furthermore, we performed a search by the State Ar-chives of the city of Bologna, to look for eventual public notices coming from city authorities in the year 1527, aimed to counteract the plague epidemic. Our investigation did find elements supporting the plague epidemics. During the entire century until 1590, the population significantly grew, and no public notices or specific laws were diffused to face the plague until the year 1557. However, it remains possible that in the quoted area some episodes of plague occurred, but luckily it was a micro-epidemic who involved a very poor area of the city, which went to a self-limitation. On our opinion, this episode proved very important, since in this last district of Bologna, and around a wooden image of “Our Lady of the Assistance”, a fraternity strongly took place, and its activities continued until the year 1798. This group of citizens had also an important role in many chari-table activity in favour of Bologna citizens, during a diffi-cult historical period The Protestant reformation, and con-tributed to strenghten the faith of Catholic believers.Nel 1527 in Italia, a seguito dell’invasione dei lanziche-necchi comandati da Georg von Frundsberg parte dell’esercito che Carlo V inviò in Italia per sottomettere gli Stati italiani aderenti alla Lega di Cognac- comparve la peste bubbonica. A Bologna dal 1527 viene praticata dai fedeli una proces-sione dal Santuario della Madonna del Soccorso che at-traversa la città fino alla Chiesa di san Rocco. Il motivo di osservanza è colle-gato alla peste. Dopo il riscontro di al-cuni casi di peste nel rio-ne del Borgo di S. Pietro, la tra-dizione riporta che avvenne, grazie all’intervento della Madonna, il miracolo dell’interru-zione dell’epidemia.  In seguito, a distanza di diversi decenni, alcuni autori bo-logne-si, non testimoni dei fatti, riportarono che il flagello aveva col-pito 12.000 persone su di una popolazione all’epoca prossima a 60.000 abitanti. Noi abbiamo rivalu-tato la questione a partire dai dati che i demografi hanno ottenuto, relativi alla popolazio-ne bolognese del XV, XVI e XVII secolo; inoltre abbiamo ri-cercato presso l’Archivio di Stato di Bologna se vi erano tracce di bandi e grida emessi in particolare nel 1527, dalle autorità

È possibile coniugare risparmio e miglioramento nelle aziende USL?

The present study aimed to evaluate if it’s possible to reduce the costs for the anti-infective medicine in a ward for the infectious disease. Analytic accounts data, related to the cost for three kind of drugs (antibiotic, antimicrobic and antriretroviral) will be presented. The analytic account is referred to the Bologna USL Firm (Presidi ospedalieri Bellaria and Maggiore) and to the Hospital Unit for the infectious disease (Ospedale Maggiore) in the year 1999. The Hospital Unit for the infectious disease consists of two ward for day of stay (32 beds), one day hospital for 10 beds and one divisional outpatients’ clinic. In 1999 there were 650 hospitalized (and discharged) patients and 783 day hospital patients. The overall cost for the Bologna USL Firm was L. 11.068.023.000, accounting L. 7.253.846.000 (65.5%) for the antiretroviral drug, L. 1.958.115.000 (17%) for the antibiotic drug and L. 1.856.062.000 (16.8%) for the antimicrobic drug and other antinfective medicine. The expenditure for the Hospital Unit for the infectious disease was L. 7.543.851.000, accounting L. 7.008.163.000 (92.9%) for the antiretroviral drug, L. 256.167.000 (3.4%) for the antibiotic drug and L. 279.521.000 (3.7%) for the antimicrobic drug and other antinfective medicine

Infecção por Malária e evolução antropológica

During the evolution of the genus Homo, with regard to species habilis, erectus and sapiens, malaria infection played a key biological role, influencing the anthropological development too. Plasmodia causing malaria developed two kinds of evolution, according to a biological and philogenetical point of view. In particular, Plasmodium vivax, Plasmodium malariae, and Plasmodium ovale, would have either coevolved with human mankind (coevolution), or reached human species during the most ancient phases of genus Homo evolution. On the other hand, Plasmodium falciparum has been transmitted to humans by monkeys in a more recent period, probably between the end of Mesolithic and the beginning of Neolithic age. The authors show both direct and indirect biomolecular evidences of malaria infection, detected in buried subjects, dating to the Ancient World, and brought to light in the course of archeological excavations in some relevant Mediterranean sites. In this literature review the Authors organize present scientific evidences: these confirm the malarial role in affecting the evolution of populations in Mediterranean countries. The people living in several different regions on the Mediterranean Sea sides, the cradle of western civilization, have been progressively influenced by malaria, in the course of the spread of this endemic disease during the last millennia. In addition, populations affected by endemic malaria developed cultural, dietary and behaviour adaptations, contributing to decrease the risk of disease. These habits were not probably fully conscious. Nevertheless it may be thought that both these customs and biological modifications, caused by malarial plasmodia, favoured the emergence of groups of people with a greater resistance against malaria. All these considered factors decreased demographical impact, influencing in a favourable way the general development and growth of civilization.Durante a evolução do gênero Homo a infecção por malária exerceu papel biológico chave, influenciando até o desenvolvimento antropológico. Os Plasmódios causadores da malária desenvolveram dois tipos de evolução, segundo um ponto de vista biológico, e filogenético. Em particular, os Plasmódios vivax, malariae, e ovale poderiam ter coevoluído com a espécie humana ou ter atingido esta durante as fases mais antigas da evolução do gênero HOMO. Por outro lado, o Plasmódio falciparum teria sido transmitido aos humanos por macacos num período mais recente, provavelmente entre o fim da Idade Mesolítica e o início da Neolítica. Os Autores mostram evidências biomoleculares, tanto diretas como indiretas, de infecção por malária, observada em indivíduos enterrados, reportando ao Mundo Antigo, e trazidas à luz no decorrer de escavações arqueológicas em alguns sítios relevantes Mediterrâneos. Nesta revisão da literatura, os autores organizam evidências modernas. Confirmam o papel da malária ao afetar a evolução das populações no Mediterrâneo. As pessoas que moram nas várias regiões do Mediterrâneo foram progressivamente influenciadas pela malária, ao longo do avanço desta doença. Além disso, as populações afetadas desenvolveram adaptações culturais, alimentares, e de comportamento, contribuindo para uma redução no risco da doença. Entretanto, pode ser que ambas modificações (as biológicas e as dos hábitos) usadas pelos Plasmódios da malária, favoreceram a emergência de grupos de pessoas com maior resistência contra a malária. Todos estes fatores considerados reduziram o impacto demográfico, influenciando de uma maneira favorável o desenvolvimento em geral, e o crescimento da civilização

Admission of foreign citizens to the general teaching hospital of Bologna, northeastern Italy: an epidemiological and clinical survey.

BACKGROUND: The emergency regarding recent immigration waves into Italy makes continued healthcare monitoring of these populations necessary. METHODS: Through a survey of hospital admissions carried out during the last five years at the S. Orsola-Malpighi General Hospital of Bologna (Italy), all causes of admission of these subjects were evaluated, together with their correlates. Subsequently, we focused on admissions due to infectious diseases. All available data regarding foreign citizens admitted as inpatients or in Day-Hospital settings of our teaching hospital from January 1, 1999, to March 31, 2004, were assessed. Diagnosis-related group (DRG) features, and single discharge diagnoses, were also evaluated, and a further assessment of infectious diseases was subsequently made. RESULTS: Within a comprehensive pool of 339,051 hospitalized patients, foreign citizen discharges numbered 7,312 (2.15%), including 2,542 males (34.8%) and 4,769 females (65.2%). Males had a mean age of 36.8±14.7 years, while females were aged 30.8±12.2 years. In the assessment of the areas of origin, 34.6% of hospitalizations were attributed to patients coming from Eastern Europe, 15.3% from Northern Africa, 7.3% (comprehensively) from Western Europe and United States, 6.9% from the Indian subcontinent, 5.9% from sub-Saharan Africa, 5.7% from Latin America, 4.1% from China, 2.5% from the Philippines, and 1.1% from the Middle East. Among women, most hospitalizations (58.8%) were due to obstetrical-gynecological procedures or diseases, including assistance with delivery (27.1%), and pregnancy complications (18.7%), followed by psycho-social disturbances (5.9%), malignancies (5.1%), gastrointestinal diseases (4.7%), and voluntary pregnancy interruption (4.4%). Among men, the most frequent causes of admissions were related to trauma (15.9%), followed by gastroenteric disorders (12%), heart-vascular diseases (8.9%), psycho-social disorders (8.4%), respiratory (7.1%), kidney (6.1%), liver (5.2%), and metabolic (4.9%) diseases, and alcohol or substance abuse (4.2%). Infectious diseases (alone or with concurrent disorders) were reported in 881 discharged individuals, representing 12.1% of the 7,312 DRGs attributed to foreign patients. The comprehensive patient population discharged from our hospital with at least one infectious disease diagnosis had lower rates of respiratory tract infections, followed by chronic viral hepatitis, HIV infection and related diseases, enterocolitis, pulmonary tuberculosis, pyelonephritis, severe skin and soft tissue infection, meningoencephalitis, and malaria, as the most frequently-reported disorders. CONCLUSIONS: Our survey, through a combined analysis of both DRGs and discharge diagnoses, allowed us to conclude that 12.1% of foreign citizens hospitalized at our General teaching Hospital of Bologna (Italy) suffered from at least one infectious disease. Respiratory tract, liver, and gastrointestinal infections, and HIV infection, were found with an appreciable frequency among discharge diagnoses, while the frequency of malaria and meningoencephalitis was lower, compared with other series. Among disorders other than infectious diseases, obstetric-gynecological conditions and post-traumatic episodes (for male patients) were the most frequent causes of hospitalization

Aggressive, Metastatic Squamous Cell Carcinoma After a 46-Year-Old History of Chronic Osteomyelitis and Local Infectious Complications: A Case Report

Marjolin's ulcer is a squamous cell carcinoma (SCC) arising from any site of established chronic inflammation, especially with presence of scar tissue.An emblematic case report of locally disseminated SCC arising from a chronic osteomyelitis of the left leg complicated by recurring soft tissue infections lasting since 46 years is presented and discussed according to the available international literature evidence. Concurrent diseases, supporting factors, clinical and histopathological presentation, differential diagnosis, and time and mode of management of this potentially functional- and life-threatening pathological condition are reviewed and discussed to offer a theme to daily clinical care