Alessandra Sensini

Breastfeeding and transmission of cytomegalovirus to preterm infants. Case report and kinetic of CMV-DNA in breast milk.

BackgroundBreastfeeding has a major impact on CMV epidemiology. Postnatal CMV reactivations incidence during lactation is nearby the maternal seroprevalence. Although perinatal CMV infection has practically no consequences in term newborn, it may cause, in some cases, a severe symptomatic disease in preterm newborns.The aims of the present study are to evaluate the rate and clinical expression of CMV infection breast milk transmitted in preterm infants and to check the safety of the freezing treated breast milk.MethodsThe study included fifty-seven preterm infants and their CMV seropositive mothers. Fresh breast milk samples have been collected from 1st to 9th postpartum week. Both fresh breast milk and 72, 96, 120 hours frozen samples have been examined, checking the presence of CMV; urine samples have been tested too.Results70.2% of tested mothers showed reactivation of the infection, and CMV-positive breast milk during the six weeks postpartum has been found. However, only one infant was infected by CMV, developing hepatic affection concomitantly with a multi-system involvement, as shown CMV DNA detection in urine, saliva, blood, gastric aspirate, and stools.ConclusionFreezing breast milk at -20°C and pasteurization may respectively reduce or eliminate the viral load.

Acute fatal necrotizing hemorrhagic encephalitis caused by Epstein-Barr virus in a young adult immunocompetent man

Epstein-Barr Virus (EBV) encephalitis is a rare (<1%) and generally self-limited disease with few sequelae. This neurological complication has been reported almost exclusively in the course of acute primary infection and in paediatric patients. We describe a case of a young adult immunocompetent man who developed an acute fatal necrotizing haemorrhagic encephalitis as the only manifestation of an acute EBV infection. EBV-DNA was tested positive in several CSF samples by qualitative and quantitative PCR. Serological profile showed: absence of IgM against Viral Capsid Antigen (VCA) in three different consecutive samples, presence of IgG against VCA and IgG seroconversion for Epstein Barr Nuclear Antigen (EBNA). EBV-DNA was detected by qualitative PCR in autoptic brain material. Clinical course was not influenced by antiviral therapy with acyclovir. In conclusion to our knowledge, this is the only case of acute necrotizing haemorrhagic EBV encephalitis with a fatal outcome, in an adult immunocompetent man.

Acute appendicitis due to Cytomegalovirus in an apparently immunocompetent patient: a case report

IntroductionIn healthy subjects, Cytomegalovirus infection can be asymptomatic or manifest as mononucleosis syndrome, but organ disease has also been reported. However, in immunocompromised patients this infection can lead to its most significant and severe disease and even mortality. When Cytomegalovirus causes a gastrointestinal tract infection, it more commonly manifests with luminal tract disease and is usually characterized by ulcerative lesions. Appendicitis is a rare manifestation, and has been reported mainly in human immunodeficiency virus-infected patients or patients with other causes of immunocompromise.Case presentationThe authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man also suffering from primary sclerosing cholangitis and ulcerative colitis. Diagnosis was based on clinical manifestations, serology results, as well as microbiological and histological findings. Treatment consisted of surgery and anti-Cytomegalovirus therapy.ConclusionsCytomegalovirus should be included among the etiologic agents of acute appendicitis in patients with primary sclerosing cholangitis and ulcerative colitis. Currently, there are no definitive data regarding the frequency of Cytomegalovirus appendicitis and the role of anti-Cytomegalovirus treatment in human immunodeficiency virus-negative and apparently immunocompetent subjects.

Association between genital mycoplasmas, acute chorioamnionitis and fetal pneumonia in spontaneous abortions

Abstract Aim: Ureaplasma parvum, Ureaplasma urealyticum and Mycoplasma hominis are also known as genital mycoplasmas. Acute chorioamnionitis is an inflammation of the placenta associated with miscarriage. We retrospectively evaluated a possible association between genital mycoplasmas detection, acute chorioamnionitis and fetal pneumonia from second and third trimester spontaneous abortions. Methods: One hundred and thirty placenta and fetal lung samples were evaluated for histological examination. The placenta samples, along with corresponding fetal tracheo-bronchial aspirates, also underwent bacterial and fungal culture and real-time polymerase chain reaction (PCR) assay for the detection of genital mycoplasmas. Results: Acute chorioamnionitis and pneumonia were diagnosed in 80/130 (61.5%) and 22/130 (16.9%) samples, respectively. Among samples positive for acute chorioamnionitis, the proportion of samples positive by real-time PCR and/or culture, was significantly higher than that of negative controls [54/80 (67.5%) vs. 26/80 (32.5%); P<0.001]. Ureaplasma parvum detection was significantly associated with acute chorioamnionitis compared to controls [9/11 (81.8%) vs. 2/11 (18.2%); P=0.019], as well as U. urealyticum [6/7 (85.7%) vs. 1/7 (14.3%); P=0.039]. Among tracheo-bronchial aspirates from abortions with pneumonia, the proportion of real-time PCR and/or culture positive samples was significantly higher than that of controls [13/22 (59.1%) vs. 9/22 (40.9%); P=0.029]. Conclusions: A strong association was found between acute histologic chorioamnionitis and microbial invasion with U. parvum and/or U. urealyticum.

Infezioni virali del sistema nervoso centrale: meningoencefaliti ed encefalopatie croniche progressive

RiassuntoIn questa rassegna sono stati descritti i principali virus che presentano uno spiccato tropismo per il sistema nervoso centrale (SNC) e sono in grado di produrre patologie sia acute sia croniche. Con l’avanzare delle conoscenze, si amplia sempre di più il pannello di virus considerati neurotropi e, di conseguenza, la necessità di idonei strumenti diagnostici. I test di amplificazione genica hanno svolto un ruolo chiave, in quanto hanno notevolmente migliorato i tempi di refertazione, la qualità della diagnosi e la tempestività terapeutica. Alcuni virus neurotropi, come quelli appartenenti alla famiglia Herpesviridae, sono ben conosciuti ed è ora possibile una diagnosi rapida e, di conseguenza, una terapia precoce. Tuttavia, altri virus appartenenti alla famiglia Picornaviridae, come i Parechovirus e l’enterovirus 71, invece, sono stati recentemente identificati come patogeni umani. Sono state anche illustrate alcune encefalopatie croniche progressive, come la panencefalite progressiva da virus della rosolia (PRP), la panencefalite subacuta sclerosante (PESS) da virus del morbillo e la leucoencefalopatia multifocale progressiva (PML) da virus JC (JCV). Infine, particolare rilievo è stato dato alle infezioni virali cosiddette “emergenti”. Cambiamenti climatici, modificazione delle abitudini sociali e culturali, mutazioni genetiche degli stessi virus e cambiamenti nell’ecologia dei vettori hanno contribuito all’emergenza di queste infezioni. Di conseguenza, l’epidemiologia delle infezioni virali del SNC sta cambiando e richiede appropriati sistemi di sorveglianza per una precoce individuazione e una tempestiva azione di controllo.SummaryIn this review the most important neurotropic viruses, able to cause acute and chronic infections, have been described. The panel of neutropic viruses is increasing and improved diagnostic tools are necessary. Molecular tests play a key role in microbiological diagnosis, because they are fast and reliable. The viruses of Herpesviridae family are well known and now a rapid diagnosis allows an early therapy. Other viruses of the Picornaviridae family, as Parechovirus and enterovirus 71, have been recently identified as human pathogens. Some chronic progressive encephalopathies, as the progressive panencephalitis by rubella virus, the subacute sclerosing panencephalitis by measles virus and the progressive multifocal leukoencephalopathy by JC virus have been illustrated. Finally, the emerging viral infections have been described. Several factors, including human and animal behaviors, travel, climate change, mutation of a pathogen genome and the changes in the ecology of vectors contribute to the emergence of infectious pathogens. As a consequence, the worldwide epidemiology of viral CNS diseases continuously evolves and enhanced surveillance regimes have been issued.