Antonella Rossati

Intrathecal/intraventricular colistin in external ventricular device-related infections by multi-drug resistant Gram negative bacteria: case reports and review

We report three cases of external ventricular derivation infections caused by multidrug-resistant Gram-negative rods and treated successfully with intraventricular colistin. The intrathecal or intraventricular use of colistin have been reported in more than 100 cases without any consensus on dosage, duration and type (monotherapy or combination therapy) of treatment. Based on our comprehensive review of the relevant literature relating to both clinical and pharmacokinetic data, we conclude that the intrathecal/intraventricular administration of colistin is a safe and effective option to treat central nervous system infections caused by multidrug-resistant Gram-negative bacteria.

Clearance of 14-3-3 Protein from Cerebrospinal Fluid Heralds the Resolution of Bacterial Meningitis

The 14-3-3 protein, a cerebrospinal fluid (CSF) marker of neuronal damage that was recently adopted for the diagnosis of Creutzfeldt-Jakob disease, is also found in the CSF of patients with a variety of neurological disorders. We prospectively studied 12 consecutive patients with purulent bacterial meningitis and found that 14-3-3 protein was detected in all patients at admission to the hospital. All patients who recovered cleared 14-3-3 protein from the CSF before discharge from the hospital (this was the first CSF marker to clear), whereas those who died never cleared the protein.

Undefined duration of opiate withdrawal induced by efavirenz in drug users with HIV infection and undergoing chronic methadone treatment.

THE CLINICAL EFFICACY of efavirenz and its pharmacokinetic profile allowing once daily administration make this drug an attractive option for the treatment of HIV infection. Efavirenz induces cytochrome P-450 (CYP) enzymes particularly CYP3A4 and CYP2B6 which take part in metabolizing numerous drugs. As a consequence the coadministration of efavirenz with several compounds undergoing CYP3A4 metabolism is contraindicated in order to avoid untoward effects resulting from drug interactions. Where intravenous drug addiction is a major risk factor for HIV infection (e.g. Italy and Spain) a substantial subset of HIV-infected subjects is under chronic treatment with methadone another compound whose metabolism mainly depends on CYP3A4 activity. In spite of the frequent coadministration of efavirenz with methadone only recently has the manufacturer released some indication regarding methadone dose adjustment in dual intakers. This was based on a study by Clarke and co-workers who found that a median 22% increase in methadone dosage was sufficient to restore a subjective state of compensation in new efavirenz recipients. (excerpt)

Elizabethkingia miricola bacteriemia in a young woman with acute alcoholic pancreatitis

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 1 septembre 2015

[The mosquito-borne viruses in Europe].

Epidemiologic changes of vector-borne diseases in recent years have multiple causes, including climate change. There are about 3500 species of mosquitoes worldwide, three-quarters of which live in tropical and subtropical wetlands. Main viruses transmitted by mosquitoes in Europe belong to the genus Flavivirus; some of them have been recently reported in Italy (Usutu and Japanese encephalitis virus), while others have been circulating for years and autochthonous transmission has been documented (West Nile virus). Mosquito-borne viruses can be classified according to the vector (Aedes or Culex), which, in turn, is associated with different vertebrate host and pathology. The Flavivirus transmitted by Culex have birds as a reservoir and can cause meningoencephalitis, while viruses transmitted by Aedes have primates as reservoir, do not have neurotropism and mainly cause hemorrhagic diseases. Other arbovirus, potentially responsible of epidemics, are the Chikungunya virus (Alphavirus family), introduced for the first time in Europe in 2007, and the virus of Rift Valley fever (Phlebovirus family). The spread in non-endemic areas of vector-born diseases have highlighted the importance of surveillance systems and vector control strategies.

Posterior reversible encephalopathy syndrome in an AIDS patient with acute renal failure and hypertension

Introduction: The posterior reversible encephalopathy syndrome (PRES) is a neurological entity characterized by magnetic resonance imaging (MRI) evidence of bilateral subcortical edema in the occipital regions of the brain. Case report: We report the case of a female patient with AIDS, pulmonary aspergillosis, CMV infection, and acute renal failure due to Clostridium difficile diarrhea. Her clinical course was complicated by seizures and hypertension. MRI findings were consistent with PRES. The patient was treated with anticonvulsants and antihypertensive agents with clinical improvement. Discussion and conclusions: Few cases of PRES in HIV-infected patients have been described, and it is not clear whether HIV infection is a predisposing factor for this syndrome. The article reviews the literature on PRES in HIV and discusses the role of HIV-associated endothelial damage in the pathogenesis of this syndrome.