111 research outputs found
First case of Mediterranean spotted fever-associated rhabdomyolysis leading to fatal acute renal failure and encephalitis
Mediterranean spotted fever (MSF) is a tick-borne zoonosis caused by Rickettsia conorii. In Italy, about 400 cases are reported every year and nearly half of them occur in Sicily, which is one of the most endemic regions. Although MSF is mostly a self-limited disease characterized by fever, skin rash, and a dark eschar at the site of the tick bite called a 'tache noire', serious complications are described, mainly in adult patients. Nevertheless, severe forms of the disease with major morbidity and a higher mortality risk have been described. We report a fatal case of MSF complicated by rhabdomyolysis, acute renal failure, and encephalitis in an elderly woman
Treatment of human brucellosis with rifampin plus minocycline
In order to evaluate the efficacy and tolerability of a high intravenous dose of rifampin plus oral minocycline (administered daily for 3 weeks) for the treatment of acute brucellosis, we retrospectively reviewed the outcome of 239 consecutive patients (135 adults and 104 children) diagnosed and treated over a 17-year period in Italy. The combination used resulted in 100% response and a relapse rate lower than 2%. Fifty-two (30 adults and 22 children) (29.8%) complained of mild adverse effects including an increase in aspartate aminotransferase (>250 IU) observed in 12 cases and considered related to rifampin and in 11 cases a reversible hyperpigmentation of the tongue attributed to minocycline. A randomized prospective comparative study should be performed to confirm our encouraging result
Pediatric visceral leishmaniasis in Western Sicily, Italy: a retrospective analysis of 111 cases
The clinical and epidemiological characteristics of 111 consecutive cases of visceral leishmaniasis identified from 1980 to 2000 in a Sicilian pediatric hospital were analyzed retrospectively. The mean age of the patients was 1.7 years. All children were HIV negative, but 15% were severely malnourished. Fever and splenomegaly were present in all cases and hepatomegaly in 101 (90.1%) cases. Thrombocytopenia and anemia were both observed in 78 (70.2%) cases and leukopenia in 47 (42.3%) cases. A bone marrow aspirate was obtained in all cases; Leishmania amastigotes were detected in 89 (80.2%) cases. Initial treatment consisted of meglumine antimoniate in 99 (89.2%) patients and amphotericin B in 12 (10.8%) patients. Only two children treated with meglumine antimoniate relapsed. The findings highlight the differences between the cases of visceral leishmaniasis observed in the Mediterranean basin and those observed in other regions. The use of the term "Mediterranean visceral leishmaniasis", rather than the term "kala-azar", is proposed for cases observed in the Mediterranean are
Human toxocariasis: a report of nine cases
Aim: Human toxocariasis is caused by infection with the larval stage of nematode parasites of dogs
and cats, Toxocara canis or Toxocara cati. These helminths are not able to complete their life cycle in
undefinitive hosts and so undergo aberrant migrations in the tissues causing a wide spectrum of
signs and symptoms. Eosinophilia is often severe and sometimes represents the only sign of
infection, except in ocular and neurological forms.
Methods: We describe the clinical features of nine children affected by toxocariasis admitted to our
Infectious Diseases department from 2004 to 2006.
Results: Fever and hepatomegaly were the most common clinical findings. In two cases eosinophilia
was not present. Diagnosis was performed by enzyme-linked immunosorbent assay employing
excretory–secretory antigens of Toxocara. canis larvae. All patients were successfully treated with oral
albendazole with no side effects
Il costo sociale del morbillo in età pediatrica. L’epidemia a Palermo nel 1996-97
Objective
To determine the direct and indirect costs associated with a measles epidemic occurring
between September 1996 and August 1997 in Palermo (Italy) in paediatric-aged patients.
Design
A total of 2,029 cases of measles in a paediatric patient population were identified from
a total of 38 paediatricians databases (24% of total). An extrapolation to the general
population was then performed to estimate a total of 9,059 cases. Patient information
obtained from the database such as patient age, risk factors, complications, vaccination
history, as well as caretaker’s profession were included in a questionnaire compiled for
each patient.
Setting
Inpatient and outpatient clinics in Palermo, Italy.
Patients and participants
Participants were paediatric-aged patients who had been diagnosed with measles. Included
in the study was a group of previously vaccinated patients (6%).
Main outcome measures and results
The average cost of care was 464.000 Italian lire (Lit.) per case with a total cost of Lit. 4,2
billion for the entire epidemic. The direct costs comprehended 46.6% (Lit. 217.000 per
case) of the total costs related to the measles epidemic and were subdivided according to
in-patient care (55.4%), paediatric outpatient visits (33.5%) and drugs (9.7%). The average
health-care cost associated to previously vaccinated patients (6%) was lower than for
non-vaccinated patients, Lit. 110.000 vs Lit. 223.000 per case, respectively.
Conclusion
The demographic and economic data obtained highlights not only the social and economic
impact of the epidemic, but also provides relevant information useful for cost-effectiveness
analysis
Efficacy and safety of clarithromycin as treatment for Mediterranean spotted fever in children: a randomized controlled trial
Fifty-one children with Mediterranean spotted fever (MSF) were randomized to receive either clarithromycin, 15 mg/kg/day orally in 2 divided doses, or chloramphenicol, 50 mg/kg/day orally in 4 divided doses, for 7 days. Mean time to defervescence was 36.7 h in the clarithromycin group and 47.1 h in the chloramphenicol group (P=.047). Clarithromycin could be an acceptable therapeutic alternative to chloramphenicol and to tetracyclines for children aged <8 years with MS
A case of Brucella endocarditis in association with subclavian artery thrombosis
Brucellosis is a common zoonosis, endemic in Mediterranean countries, and caused by bacteria of Brucella genus. Brucellosis is a systemic infection and the clinical presentation varies widely from asymptomatic and mild to severe disease. Cardiovascular complications are extremely rare. We present a case of arterial thrombosis in a previously healthy young patient with Brucella endocarditis. Careful attention must be paid to any sign or symptom of thrombosis in patients affected by brucellosis, regardless of the presence of endocarditis and cardiovascular risk factors.
PMID:22844622[PubMed] PMCID:PMC3400327Free PMC Articl
Disseminated tuberculosis in a patient treated with a JAK2 selective inhibitor: a case report
Background
Primary myelofibrosis is a myeloproliferative disorder characterized by bone marrow fibrosis, abnormal cytokine expression, splenomegaly and anemia. The activation of JAK2 and the increased levels of circulating proinflammatory cytokines seem to play an important role in the pathogenesis of myelofibrosis. Novel therapeutic agents targeting JAKs have been developed for the treatment of myeloproliferative disorders. Ruxolitinib (INCB018424) is the most recent among them.
Case presentation
To our knowledge, there is no evidence from clinical trials of an increased risk of tuberculosis during treatment with JAK inhibitors. Here we describe the first case of tuberculosis in a patient treated with Ruxolitinib, a male with a 12-year history of chronic idiopathic myelofibrosis admitted to our Institute because of fever, night sweats, weight loss and an enlarging mass in the left inguinal area for two months.
Conclusion
Treatment with Ruxolitinib may have triggered the reactivation of latent tuberculosis because of an inhibition of Th1 response. Our case highlights the importance of an accurate screening for latent tuberculosis before starting an anti-JAK 2 treatmen
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