Influenza A/H1N1/2009 virus - experience of the clinical microbiology laboratory of the "L. Sacco" University Hospital in Milan

In the spring of 2009, a new variant of influenza A/H1N1 virus that had never been isolated before, was identified. From April 27 to December 31, 2009 the respiratory samples of 974 patients, obtained from suspected cases of pandemic influenza A virus infection, were analyzed at the Clinical Microbiology Laboratory of the "L. Sacco" University Hospital in Milan. The diagnosis of influenza A/H1N1 infection was performed initially through the use of different molecular biological methods: Seeplex® RV12 ACE Detection (Seegene), NUCLISENS® EASYQ® INFLUENZA A/B (bioMérieux), Influenza A/B Q-PCR Alert (Nanogen) running in parallel with rRT-PCR (CDC) to confirm the positivity to the new influenza virus, then was used a single specific test, Fast set H1N1v (Arrow Diagnostics). Retrospective study of data showed that 293 (30.1%) patients were positive for the new strain of influenza A/H1N1 virus and 8 (0.8%) for influenza A other than H1N1 virus.The distribution of influenza A/H1N1 cases showed two peaks, one on July (62.9%) and the other one on October (36%), moreover we observed that 155 patients (53%) out of 293 positive for influenza A/H1N1 virus aged under 20 years old. The first positivity peak was found in travelers and the second one, occurred 2-3 months prior to the classic seasonal epidemic influenza, was attributed to autochthonous cases , by which the virus had spread worldwide. The highest proportion of cases were among subjects aged from 0 to 20 years and, over this age the positivity rate decreased proportionally with increasing age, in agreement with data reported in other countries

West Nile virus transmission. results from the integrated surveillance system in Italy, 2008 to 2015

IIn Italy a national Plan for the surveillance of imported and autochthonous human vector-borne diseases (chikungunya, dengue, Zika virus disease and West Nile virus (WNV) disease) that integrates human and veterinary (animals and vectors) surveillance, is issued and revised annually according with the observed epidemiological changes. Here we describe results of the WNV integrated veterinary and human surveillance systems in Italy from 2008 to 2015. A real time data exchange protocol is in place between the surveillance systems to rapidly identify occurrence of human and animal cases and to define and update the map of affected areas i.e. provinces during the vector activity period from June to October. WNV continues to cause severe illnesses in Italy during every transmission season, albeit cases are sporadic and the epidemiology varies by virus lineage and geographic area. The integration of surveillance activities and a multidisciplinary approach made it possible and have been fundamental in supporting implementation of and/or strengthening preventive measures aimed at reducing the risk of transmission of WNV trough blood, tissues and organ donation and to implementing further measures for vector control

Imported arboviral infections in Italy, July 2014-October 2015: A National Reference Laboratory report

BACKGROUND: Imported cases of infections due to Dengue (DENV) and Chikungunya (CHIKV) viruses and, more recently, Zika virus (ZIKV) are commonly reported among travelers returning from endemic regions. In areas where potentially competent vectors are present, the risk of autochthonous transmission of these vector-borne pathogens is relatively high. Laboratory surveillance is crucial to rapidly detect imported cases in order to reduce the risk of transmission. This study describes the laboratory activity performed by the National Reference Laboratory for Arboviruses (NRLA) at the Italian National Institute of Health in the period from July 2014 to October 2015. METHODS: Samples from 180 patients visited/hospitalized with a suspected DENV/CHIKV/ZIKV infection were sent to the NRLA from several Italian Hospitals and from Regional Reference Laboratories for Arboviruses, in agreement with the National Plan on human surveillance of vector-borne diseases. Both serological (ELISA IgM test and Plaque Reduction Neutralization Test-PRNT) and molecular assays (Real Time PCR tests, RT-PCR plus nested PCR and sequencing of positive samples) were performed. RESULTS: DENV infection was the most frequently diagnosed (80 confirmed/probable cases), and all four genotypes were detected. However, an increase in imported CHIKV cases (41 confirmed/probable cases) was observed, along with the detection of the first ZIKV cases (4 confirmed cases), as a consequence of the recent spread of both CHIKV and ZIKV in the Americas. CONCLUSIONS: Main diagnostic issues highlighted in our study are sensitivity limitations of molecular tests, and the importance of PRNT to confirm serological results for differential diagnosis of Arboviruses. The continuous evaluation of diagnostic strategy, and the implementation of laboratories networks involved in surveillance activities is essential to ensure correct diagnosis, and to improve the preparedness for a rapid and proper identification of viral threats

Building Information Resilience: How do Resettling Refugees Connect with Health Information in Regional Landscapes - Implications for Health Literacy

The study explores how resettling refugees experience a new health environment and develop health literacy practice. The concept of information resilience, which emerges from the grounded experiences of learning to live well is introduced. The study also explores how health narratives are constructed, disseminated and circulated by this particular cohort

Resistenza ai principali antibiotici dei microrganismi isolati presso l’ospedale “Luigi Sacco” di Milano nel periodo 1997-2001

Antibiotic resistance of commonly isolated bacterial species at “L. Sacco” Hospital of Milan (Italy) is evaluated in the period 1997-2001. Staphylococcus aureus and Staphylococcus epidermidis are quite completely resistant to penicillin, while the agents with β-lactamase inhibitors are more active against Staphylococcus aureus than against Staphylococcus epidermidis. Also cephalotin and eritromycine are more active against Staphylococcus aureus than against Staphylococcus epidermidis. Cephalosporins are active against beta-haemolytic streptococci, while Streptococcus pyogenes shows a resistance of 25-30% against erytromicin. For Streptococcus pneumoniae there is a sporadic, not increasing, resistance to penicillin. Enterococcus faecalis shows an increasing resistance for the year 2001 against cotrimoxazole, but ampicillin and imipenem are always active against this species. Aztreonam is always active against Escherichia coli, while there is resistance to piperacillin (20-25%) and ampicillin (35-45%). Resistance to cephalotin is increasing in time, while cefotaxime is always active. For Haemophilus influenzae there is a certain resistance to ampicillin (10-20%). Pseudomonas aeruginosa is often resistant to widespectrum penicillins and to imipenem and ciprofloxacin (30%). With the only exclusion of a great increase of resistance of Enterococcus faecalis to cotrimoxazole in the year 2001, all the other patterns of resistance appear to be comparable in each of the five years considered. Substantially we do not observe an increase of antibiotic resistance

Valutazione di un test per la determinazione simultanea degli anticorpi e antigene p24 dell’HIV

A fourth generation immunoassay for the detection of antibodies to HIV-1 and HIV-2 and of HIV antigen p24 (Abbott Architect HIV Ag/Ab Combo) has been evaluated in comparison with two Ab-only third generation assays on 894 routine specimens and on preselected repository specimens.The Combo assay showed a better specificity (99.88% vs. 99.43-99.83%) and an analytical sensitivity for p24 of 22 pg/mL on a BBI commercial panel. The Architect assays gave a negative result on 22/24 repository false positive specimens from 18 subjects and, conversely, was positive on all the 39 repository specimens from 24 HIV-positive patients. On six patients with acute HIV infection the Architect assay gave an earlier positivity than the antibody-only assays (EIA and WB) on three cases, all viremic and positive for HIV p24.The performance characteristics of the new HIV Combo assay guarantee an advanced clinical sensitivity and a high specificity

Reaction-induced mantle weakening at high-pressure conditions: An example from garnet pyroxenites of Ulten Zone (Eastern Alps, N Italy)

Peridotites of Ulten Zone (Eastern Alps, N Italy) show a transition from coarse protogranular spinel lherzolites to fine-grained amphibole + garnet peridotites, recorded by the crystallization of garnet coronas around spinel. Pyroxenite veins, transposed along the peridotite foliation, show a similar metamorphic evolution from coarse-grained (garnet-free) websterites to fine-grained garnet websterites. In both peridotites and websterites, garnet previously exsolved from porphyroclastic high-temperature pyroxenes and later crystallized along the foliation. This evolution has been interpreted to reflect cooling and pressure increase of websterites and host peridotites from spinel- to garnet-facies conditions. Microstructures and crystallographic orientation data indicate that the re-equilibration of garnet websterites in the garnet stability field occurred during deformation. Porphyroclastic pyroxenes have been interpreted to deform by dislocation glide and creep. In particular, TEM observations indicate the activation of the (100)[010] slip system in orthopyroxene. Core-and-mantle microstructures also suggest that dislocation creep was aided by subgrain rotation recrystallization, leading to the formation of neoblastic pyroxenes. These recrystallized grains deformed by diffusion-accommodated grain boundary sliding, as indicated by the occurrence of quadruple junctions and straight, aligned grain boundaries. The transition from dislocation creep to diffusion creep in websterites was accompanied by the crystallization of garnet along foliation, which triggered the pinning of the recrystallized matrix and stabilized the fine-grained microtexture for diffusion creep, promoting rheological weakening. Garnet websterites of Ulten Zone thus offer a unique opportunity to investigate the effects of reaction softening during the corner flow in the supra-subduction lithospheric mantle induced by the descending slab

Evaluation of the Abbott LCx HIV-1 RNA Quantitative, a New Assay for Quantitative Determination of Human Immunodeficiency Virus Type 1 RNA

A new quantitative reverse transcription (RT)-PCR assay for human immunodeficiency virus type 1 (HIV-1) RNA (Abbott LCx HIV RNA Quantitative assay) has been compared with the Organon NucliSens assay on 521 retrospective samples obtained from HIV-1-positive patients monitored during highly active antiretroviral therapy, 79 of whom were assayed also by the Chiron Quantiplex 3.0 system and on characterized panels. The LCx system showed a moderate correlation (r = 0.795) and gave higher results than the NucliSens system on 245 of 327 concordant positive samples, with similar sensitivity. Correlation with Quantiplex system results was higher (r = 0.943). LCx reproducibility was very good; the procedure was simple, well controlled, and rapid (up to 48 results in 7 h). The HIV RNA quantitative assay on the LCx system is suitable for routine use

New viral gastrointestinal agents associated with paediatrics illness

Objective Aim of our study was investigate the presence of enteric viruses like Norovirus, Bocavirus and Rotavirus in hospitalized children belong to Paediatrics Clinics of L. Sacco Hospital. Material and methods 150 faecal samples were investigated from January 2008- 2009, by PCR real time for Norovirus and Bocavirus; Rotavirus was detected by enzyme immunoassay. Results We obtain a positive result on total samples in percentage of 36%: Rotaviruses are estimated to cause more than 20% of gastroenteritis cases; Noroviruses 7.3% cases; Bocaviruses 6.6% cases. Rotaviruses infections occurred in children 1-4 years of age and for 2 cases at 7 and 13 years old. Illness typically happened in the cooler months from January to March even if there were few positive cases in September/October. Noroviruses and Bocaviruses infections occurred in children 1-2 years of age and their seasonality were respectively from September to December and from January to March for Bocaviruses. Conclusions The present results point out the importance to detect new viral gastrointestinal agents associated with paediatric illness