Rickettsia typhi and Haemophagocytic Syndrome

Appropriate therapy (dexamethasone, cyclosporin, and etoposide) could save the patient in those cases in which the pathogen-direct therapy has not been sufficient by itself to control the disease

Leprosy-like cutaneous presentation of Histoplasma capsulatum infection in an African HIV+ patient

Histoplasma capsulatum is an opportunistic dimorphic fungus responsible for most often self-limiting or flu-like infections but potentially lethal in immunocompromised hosts. Histoplasmosis is rare in Europe. We reported a case of disseminated histoplasmosis in an African HIV patient with a leprosy-like primary cutaneous presentation and involvement of lungs, brain, limphnodes and eye. The therapy with liposomial B amphotericin and itraconazole led to a prompt resolution of the symptoms

REVISITING ANTHROPOZOONOSES IN THE MEDITERRANEAN BASIN. A SINGLE-CENTRE PERSPECTIVE. A SOUTHERN ITALIAN EXPERIENCE

Zoonoses, often better defined with the term anthropozoonoses, are diseases that can be transmitted to humans either by direct contact with animals or through arthropod vector intervention. Microbial interaction between humans and animals constitutes an important public health challenge, particularly in the Mediterranean basin. The main reasons this challenge is still relevant today include the phenomenon of migration, of both humans and animals, and climate change, which tend to alter the geographical distribution of zoonosis or the zoonotic agent, as well as the distribution range of potential vectors. The Mediterranean area seems to be affected by plentiful and widely distributed zoonoses, the main diseases being rickettsiosis, leishmaniasis, brucellosis, hydatid disease and viral zoonoses. The aim of this study is to revisit the prevalence and main clinical features of anthropozoonoses observed at the Department of Sciences for Health Promotion and Mother & Child Care, University of Palermo, Sicily, Southern Italy

Chest ultrasound in italian geriatric wards: Use, applications and clinicians’ attitudes

Background and aims. Bedside chest ultrasound has emerged as a versatile and accurate diagnostic tool for the management of respiratory conditions in several clinical settings, integrating traditional imaging. The current utilization of this technique in geriatric hospital wards is still unknown. Our aim was to assess availability, uses and applications of chest ultrasonography in a convenience sample of 25 Italian geriatric wards. Methods. A questionnaire, based on the current literature state-of-the-art, was e-mailed to head doctors of geriatric wards of Italian hospitals. The questionnaire explored ultrasound equipment availability, practice of chest ultrasound, expertise of ward physicians, clinical indications, and perceived impact on patient care. Results. Ultrasound equipment was available in 92% of wards, and chest ultrasound was performed in 82% of cases. Among the wards where chest ultrasound was performed, it was considered as routine assessment in only 52% of cases, mainly for diagnosis of pleural effusions (95%) and acute heart failure (89%), assessment of volemic state (79%), and assistance to invasive procedures (79%). It was used in emergency/ urgency assessment of acute dyspnea in only 53% of cases. In most wards, only three or less physicians were able to perform chest ultrasound. In 53% of cases, head doctors declared that they perceived benefits of chest ultrasound in patient care in only selected cases. Conclusions. Chest ultrasound utilization in Italian geriatric wards is inhomogeneous, and the number of trained physicians is still limited. Geriatricians’ attitude towards chest ultrasound is generally cautious. Research and training programs are needed to spread the correct use of this technique in geriatric practice

ACALCULOUS CHOLECYSTITIS IN A PATIENT WITH PLASMODIUM FALCIPARUM MALARIA AND CYTOMEGALOVIRUS INFECTION

Acalculous cholecystitis is a syndrome of gallbladder inflammation without gallstones, recognized within the setting of critically ill patients. Acalculous cholecystitis associated with infectious agents is reported in the literature to be rare. Herein we describe a case of acalculous cholecystitis in a patient with malaria caused by Plasmodium falciparum and apparent cytomegalovirus infection, and discuss the possible role of CMV in the pathogenesis of acalculous cholecystitis in patients with malaria

Nuclear Stellar Disks in Spiral Galaxies

We report evidence for nuclear stellar disks in 3 early-type spirals, namely NGC 1425, NGC 3898 and NGC 4698, revealed by WFPC2/F606W images out of a sample of 38 spiral galaxies, selected from the Hubble Space Telescope Data Archive. Adopting the photometric method introduced by Scorza & Bender we derived their central surface brightness and scalelength by assuming them to be infinitesimally thin exponential disks. No nuclear disk was found in barred galaxies or galaxies of Hubble type later than Sb. The external origin of the disk in NGC 4698 is strongly suggested by its orthogonal geometrical decoupling with respect to the host galaxy

Mediterranean visceral leishmaniasis in immunocompetent children. Report of two cases relapsed after specific therapy

Visceral leishmaniasis (VL) is endemic in areas bordering the Mediterranean Sea (Spain, Italy, France, Greece, Morocco, Tunisia) where it is caused by Leishmania infantum and is transmitted by the bite of a hematophagous sandfly belonging to Phlebotomus spp.; the dog constitutes the main reservoir of infection. Two cases of VL in immunocompetent children are described. Both patients lived in endemic areas for leishmaniasis (Sicily) and at admission were febrile, pale and had splenomegaly. In both patients anti-leishmania antibodies were present and a definitive diagnosis was confirmed by demonstration of leishmania parasites by microscopy or polymerase chain reaction (PCR) in the bone marrow aspirates. The use of PCR performed on peripheral blood has been reported to be highly sensitive for the diagnosis and follow-up of children with VL. One patient was treated with N-dimethylglucamine, Glucantim, the other one with liposomal Amphotericin B (AmBisome). Both had symptomatic relapses 3 months later, and recovered following re-treatment with AmBisome administered intravenously at a dosage of 3 mg/Kg for ten consecutive days. The patients were monitored for one year after treatment was complete

Monocyte to lymphocyte blood ratio in tuberculosis and HIV patients: Comparative analysis, preliminary data

Recent data confirmed the hypothesis suggested by historical studies that the ratio of peripheral blood monocytes to lymphocytes (M/L) is associated with the risk of tuberculosis (TB) disease. We retrospectively analyzed the electronic health records of tuberculosis and HIV-positive patients who had followed day-care programs at the AIDS Center of the University of Palermo, Italy. 261 patients were recruited and divided into 6 groups as follows: healthy control group (HCG: 47 pts), latent HIV negative infected TB group (LIG, 43 pts), active HIV negative tuberculosis (TAG: 61 pts), treated tuberculosis HIV negative (TTG: 44 pts), HIV drug-naive patients tested TST and QFT-IT-negative with negative chest x-Ray (HIVnG: 44 pts), and HIV-tuberculosis coinfection (HIVTB-G: 22 pts). For each group, absolute lymphocyte (L), monocyte (M) and M/L ratio by peripheral blood was calculated. The mean value of monocytes in the TAG group was significant, the highest (0.70\uc2\ub10.37 1x103/\uce\ubcl) in comparison to HGC (0.70>0.44, p-value <0.05), HIVnG (0.70>0.40, p-value <0.05) and HIVTB-G (0.70>0.45, p-value<0.05). Monocyte to lymphocyte blood RATIO showed a significant difference between groups (p-value <0.001). In particular, the mean score of M/L ratio was higher in the TAG group compared to the HGC (0.49>0.27, p-value<0.05), LIG (0.49>0.29, p-value<0.05), TTG (0.49>0.32) and HIVTB-G groups (0.49>0.27, p-value<0.05). Our data confirm a significant difference in monocyte to lymphocyte blood ratio in tuberculosis disease. These data may be useful for monitoring and revising implementation plans for the different phases of tuberculosis disease (latent Mycobacterium tuberculosis (MTB) infection versus TB active disease). Regarding HIV samples, the small sample size is somewhat offset by the need, fully satisfied in our sample, to enlist specific patients such as co-infected HIV/TBC who voluntarily submit to clinical trials in our geographical area