Protocollo di valutazione infettivologica pre-trapianto

Lo screening pre-trapianto dei potenziali candidati a un trapianto d\u2019organo \ue8 parte essenziale del trapianto di organi solidi. Obiettivi dello screening pre-trapianto sono: 1. identificazione di condizioni che controindicano il trapianto; 2. identificazione e trattamento di infezioni attive pre-trapianto; 3. definizione del livello di rischio infettivo e impostazione di strategie preventive post-trapianto. Nonostante vi sia un generale accordo sulle indagini di screening da effettuare, vi sono alcune variazioni tra i diversi centri. Allo scopo di armonizzare lo screening infettivologico pre-trapianto, viene schematicamente riportato, alla luce dell\u2019esperienza personale e dei dati di letteratura, lo stato dell\u2019arte inerente lo screening infettivologico pre-trapianto

Polymerase chain reaction in the diagnosis and prognosis of Mediterranean visceral leishmaniasis in immunocompetent children

OBJECTIVE: To assess the usefulness of a polymerase chain reaction (PCR) assay amplifying the small subunit rRNA coding region of Leishmania species performed on peripheral blood (PB) and bone marrow (BM) aspirates for the diagnosis and follow-up of visceral leishmaniasis (VL) in children living in the Mediterranean basin. DESIGN: A prospective study was conducted on children consecutively hospitalized over a 1-year period at our Infectious Diseases Department in Sicily (Italy) presenting with fever, hepatosplenomegaly, and/or pancytopenia and a positive Leishmania serology (> or =1:40). RESULTS: Among the 14 patients hospitalized with signs and symptoms suggestive of the disease and a positive serology, we identified 10 cases of Mediterranean VL. PCR performed on PB and BM aspirates was positive in all cases and concordant with microscopy and/or culture performed on BM. Leishmania DNA was cleared from PB a median of 6 days after the start of treatment; during follow-up (median: 9 months; range: 6-12 months) 1 child relapsed. In this case, BM PCR remained positive with rapid reappearance of a positive signal also in PB. CONCLUSIONS: PB PCR allows a rapid and noninvasive parasitologic diagnosis of Mediterranean VL among immunocompetent children and is at least as sensitive as a diagnosis made on the basis of BM aspirates. The lack of disappearance from BM and the reappearance of positive PCR on PB is predictive of clinical relapse. Qualitative and semiquantitative PCR may be the standard method for monitoring response to therapy in immunocompetent childre

Prevalence and risk determinants of HIV-1 and HIV-2 infections in pregnant women in Bissau

Objectives : To analyse the risk determinants of HIV-1 and HIV-2 infections in pregnant women in Bissau. Methods Pregnant women attending the antenatal clinics of Bissau between January 2002 and June 2006 were consecutively tested unless they opted out. Results Among 23,869 tested women the overall prevalence of HIV-1 was 5.7%, that of HIV-2 was 2.4%, and these included the 0.7% prevalence of HIV-1 and HIV-2 duals. The main factors associated with the risk of HIV-1 infection were older age, occupation and number of sexual partners. Beafada and Mandinga ethnic groups were at greater risk of presenting HIV-1, and Bijago and Papel at lower risk. The factors associated with the risk of HIV-2 were age, literacy and occupation; the Beafada were at greater risk than the other ethnic groups. Conclusions : The prevalence of HIV-2 infection decreased overtime, whereas that of HIV-1 infection remained substantially stable, but was higher than that observed in previous studies. The rapid decline in the rates of HIV-2 infection suggests that many of the factors that allowed its exponential growth in the past have now been partially removed, and that sexual and vertical transmission have not been sufficient to maintain and extend the epidemic