Anna Lucchini

Tracheobronchial aspergillosis in a patient with AIDS treated with aerosolized amphotericin B combined with itraconazole.

Summary. The clinical features of a tracheobronchial infection due to Aspergillus flavus in an AIDS patient with a normal neutrophil count is described. Diagnosis was made by culture and microscopic examination of biopsies obtained from bronchial vegetations seen at bronchoscopy. Radiographic examination of the neck revealed the presence of large endoluminal fungal masses. Initially the patient was treated with a combination of itraconazole, flucytosine and aerosolized amphotericin B, then only with itraconazole plus aerosolized amphotericin B. A good therapeutic response was observed.

Louseborne Relapsing Fever among East African Refugees, Italy, 2015

During June 9–September 30, 2015, five cases of louseborne relapsing fever were identified in Turin, Italy. All 5 cases were in young refugees from Somalia, 2 of whom had lived in Italy since 2011. Our report seems to confirm the possibility of local transmission of louse-borne relapsing fever.

Diagnosis of dengue fever in North West Italy in travelers from endemic areas: A retrospective study

BACKGROUND Domestic outbreaks of Dengue (DENV) fever from imported cases have to be considered a possible risk in non-endemic countries where Dengue vectors are present, such as in Italy. OBJECTIVE To review imported acute/recent DENV infections in a one-year survey in a North West Italy region where the presence of Aedes albopictus is documented. STUDY DESIGN We retrospectively reviewed laboratory and clinical records of Italian febrile travelers from Dengue endemic areas referring to the local reference Centre for Infectious Disease, covering a population of about 4 million people. RESULTS Acute/recent DENV infection was identified in 15 out of 91 travelers from endemic areas (16.5%) including 12 primary and 3 secondary infections; in 6 patients the virus was detectable in blood according to molecular real-time Polymerase Chain Reaction-based assays: in 9 patients the diagnosis of DENV infection was accomplished by the combination of specific IgM reactivity, high IgG titers, IgG seroconversion from negative to positive and increasing (four-fold) IgG titers in paired serum samples. Two cases of DENV infections were imported from South Egypt in patients travelling together, confirming the importance of returning travelers as sentinels of a rapidly changing epidemiology in specific geographic areas. CONCLUSIONS Our findings outline the high rate of imported Dengue infection in North West Italy and emphasize the need for a continued Dengue surveillance in non-endemic countries as well as a careful evaluation and follow-up of febrile patients returning from Dengue endemic countries.

Moxifloxacin for the treatment of HIV-associated tuberculosis in patients with contraindications or intolerance to rifamycins

Administration of rifampicin or rifabutin in the treatment of HIV-associated tuberculosis (TB) is made rather complex by the risk of drug-drug interactions with most antiretrovirals and/or for reasons of toxicity. While in selecting the appropriate concomitant regimens the priority usually goes to rifamycins with exclusion of interacting antiretrovirals, in some circumstances the former cannot be used and anti-TB rifamycin-free regimens must be administered. We describe here the clinical course of two patients with HIV-associated TB in whom the last generation fluorquinolone moxifloxacin (found to exert significant activity against Mycobacterium tuberculosis) successfully replaced rifamycins.

Sexually transmitted infections in Italy: an overview.

In Italy more than 240,000 and 500,000 cases of gonorrhoea and syphilis, respectively, were reported in 1936 but the incidence progressively fell to about 200-300/year by the early 1990s; data available now are probably 100-150% underestimated. An inefficient notification system, diversion of public funding to other fields, and the progressive decline in importance of dermatovenereological centres are responsible for this decline. The advent of the HIV epidemic (with more than 47,000 AIDS reported cases) has drained most public health resources away from the very limited interventions for the control of traditional sexually transmitted infections (STIs). This has led some groups to attempt alternative approaches to the HIV/STI prevention and treatment policies; the potential of these new experiences need to be assessed. A change in culture of the medical body politic is now essential in order to support medical professionals, administrators and programme managers seeking to implement proper STI control programmes.

Clinical and microscopical features of small-intestinal microsporidiosis in patients with AIDS.

SummaryIntestinal microsporidiosis byEnterocytozoon bieneusi is an increasingly recognized infection in AIDS patients. We report eight cases of microsporidiosis. All patients were severely immunodepressed. Clinical features were highly variable. Patients were followed up for a mean period of 7.8 months. All patients had persistent infection during the follow-up and spore excretion remained constant. Two patients became asymptomatic during the follow-up. None of the patients presented clinical and echographic signs of biliary involvement. Treatment with albendazole, metronidazole or paromomycin failed to produce a durable clinical response or to eradicate the organism. Cases were identified by stool examination and additionally investigated with light and electron microscopy. It was found that light microscopy was a sensitive method, while electron microscopy was less sensitive but allowed the definition of the infecting species. The modified trichrome stain was a satisfactory method for diagnosis on fecal smears. The calcofluor stain and the combination of DAPI with calcofluor was a rapid and simple staining method for screening.ZusammenfassungBei AIDS-Patienten werden mit zunehmender Häufigkeit Fälle von intestinaler Mikrosporidiose durchEnterocytozoon bineusi beobachtet. Wir berichten über 11 Mikrospordiosefälle. Bei allen Patienten bestand eine schwere Immundefizienz. Die klinische Symptomatik war sehr variabel. Die Patienten wurden im Mittel 7,8 Monate lang beobachtet. Alle Patienten hatten während der Beobachtungszeit eine persistierende Infektion und die Exkretion der Sporen blieb konstant. Zwei Patienten wurden während der Beobachtungszeit asymptomatisch. Bei keinem der Patienten bestanden klinische oder sonographische Zeichen für eine Beteiligung der Gallenwege. Die Therapie mit Albendazol, Metronidazol oder Paromomycin führte nicht zu einer bleibenden klinischen Besserung oder Erregereradikation. Die Diagnostik erfolgte durch Stuhluntersuchung unter Anwendung von Licht- und Elektronenmikroskopie. Die Lichtmikroskopie erwies sich als empfindliche Methode. Die Elektronenmikroskopie war weniger empfindlich, erlaubte jedoch die Spezifizierung des Erregers. Eine modifizierte Trichrom-Färbemethode war für die Beurteilung von Stuhlausstrichen brauchbar. Die Calcofluor-Färbung und die Kombination von DAPI mit Calcofluor erlaubte eine rasche und einfache Beurteilung für das Screening.

Meningoencephalitis caused by Toxoplasma gondii diagnosed by isolation from cerebrospinal fluid in an HIV-positive patient.

Toxoplasmosis of the central nervous system is a frequent opportunistic infection in AIDS patients, usually presenting as a mass brain lesion detected by computerized axial tomography scanning or magnetic resonance imaging. A case of diffuse meningoencephalitis with no radiological evidence of brain lesions is described. Diagnosis was made by culturing cerebrospinal fluid (CSF) on THP1 cells where tachyzoites of Toxoplasma gondii were demonstrated after 8 days of incubation by both direct observation and immunofluorescence. CSF examination with culture should be considered in AIDS patients with neurological signs and symptoms but without radiological evidence of cerebral lesions.

Rapid diagnosis of malaria by use of fluorescent probes.

Malaria diagnosis relies on observation of parasites in blood smears and the Giemsa-stained thick blood smear (G-TS) is the reference test. Diagnosis by G-TS in low-density infections requires long periods of observation and experienced microscopists. Examination of Giemsa-stained thin smears enables more reliable differentiation of species but may miss low-grade infections. Fluorescent stains may offer an alternative technique. We compared the Giemsa technique with 4,6-diamidine-2-phenilindolo-propidium iodide (DAPI-PI) stainings in order to evaluate the time required for diagnosis. A Plasmodium falciparum-infected blood specimen was diluted to obtain concentrations ranging from 6192 to 24 parasites/microliters (p/microliter), and thin and thick smears were stained with the two methods. The DAPI-PI proved useful: parasites were easily recognized and their morphology was preserved in thin and thick smears. The method allowed more rapid evaluation of thin smears as compared with Giemsa staining and enabled recognition of parasites in case of low-level parasitemias. The DAPI-PI staining technique may acquire an important role in malaria diagnosis, especially in nonendemic countries where technicians are not experienced with G-TS; in developing countries, it could be used in epidemiologic surveys of populations with low-density parasitemias, for which it enables a fast examination of smears and possibly the identification of parasite species.

Lopinavir Measurement in Pleural Effusion in a Human Immunodeficiency Virus Type 1-Infected Patient with Kaposi's Sarcoma

Human immunodeficiency virus type 1 (HIV-1) infection is highly compartmentalized within various organs. Tissue dissemination is evident in the lung ([1][1]), the male ([3][2]) and female ([8][3]) genital tracts, the lymph nodes ([12][4]), and especially in the brain ([5][5], [12][4]). This process

The Karpas AIDS Cell Test compared with an enzyme-linked immunosorbent assay for detecting antibody to the human immunodeficiency viruses (HIV-1 and HIV-2)

We have compared the Karpas AIDS Cell Test for antibodies to the human immunodeficiency viruses (HIV) with a commercial enzyme-linked immunosorbent assay (ELISA) (Organon Teknika) by testing serum samples from 324 intravenous drug abusers in Turin. The cell test was found to be more sensitive and as specific as the ELISA with the serum samples from the drug abusers. In Lisbon, 30 samples were tested on slides containing cells infected with HIV-1 and/or HIV-2. All 15 samples, which were positive for HIV-2 alone (in the HIV-2 Elavia test and by the Western blotting technique), were also positive in the Karpas AIDS test. In contrast, only one of the 15 samples (7%) gave a positive reading in the ELISA for HIV-1. Results of 30 samples tested in Turin and Lisbon by the Western blotting technique agreed closely with those obtained with the Karpas AIDS Cell Test. We were also able to show that the entire test can be performed at room temperature and completed within 1 hour. Moreover, the cell test requires minimal skill and simple equipment and is inexpensive. It also includes non-infected cells as a control and the specificity of positive samples may be verified with a bench microscope. Furthermore, this test which detects antibodies to both HIV-1 and HIV-2 allows rapid typing of the infecting strain.