Elisa Burdino

Kinetics and prediction of HBsAg loss during therapy with analogues in patients affected by chronic hepatitis B HBeAg negative and genotype D

In patients affected by chronic hepatitis because of HBV infection, long‐term suppressive therapy with nucleos(t)ides analogues in the HBeAg− patients has shown low effects on HBsAg titre (qHBsAg) decrease, and HBsAg loss is difficult to achieve. Thus, in this type of patients the main goals of antiviral therapy is the suppression of HBV‐DNA and ALT normalization.

Recent outbreak of aseptic meningitis in Italy due to Echovirus 30 and phylogenetic relationship with other European circulating strains

BACKGROUND Enteroviruses (EVs) are common human viral pathogens, causing a variety of diseases, including aseptic meningitis. Recently, EV aseptic meningitis outbreaks have been reported across Europe, but, in Italy, knowledge of recent EV molecular epidemiology is very limited. OBJECTIVES We report an outbreak of EV aseptic meningitis in 10 adults in North-Western Italy, from October to November 2012. Patients were parents or close relatives of children <5 years old attending the same class of a nursery school, suffering from a mild febrile upper respiratory disease. Phylogenetic relationship with other European circulating strains was analyzed updating E30 circulation in Italy in recent years. STUDY DESIGN EVs were detected from cerebrospinal fluid (CSF) specimens with a real-time reverse transcription polymerase chain reaction and virus isolation was achieved from rectal and pharyngeal swabs. For cluster definition and phylogenetic studies, viral VP1 region was directly amplified and sequenced from CSF. RESULTS EVs were identified in CSF from all patients and from rectal and pharyngeal swabs in 7 of them. Direct sequencing of CSF revealed the presence of the same Echovirus 30 (E30) in all patients and phylogenetic analysis identified it as a diverging clade within E30 genotype VII, the most recent strain circulating in UK, Finland and Denmark since 2006. CONCLUSION Molecular techniques allowed the rapid identification and typing of E30 from CSF. Phylogenetic analysis revealed that the cluster might be due to a new E30 variant within the genotype VII currently circulating in Europe, thus updating the epidemiology of EV circulation in Italy.

Combination of conventional blood cultures and the SeptiFast molecular test in patients with suspected sepsis for the identification of bloodstream pathogens

We evaluated performances of the molecular test SeptiFast (SF) for the detection of agents of bloodstream infection (BSI) in patients with suspected sepsis, the majority of them under antibiotic treatment and at high prevalence of HIV-1 infection (10.5%). Matched SF and blood culture (BC) samples (n=1186) from 1024 patients were studied. Two hundred fifty-one episodes of BSI out of 1144 were identified with the combined methods (22%). SF identified more episodes of BSI than BC: 206 versus 176 (χ(2)=7.008, P=0.0081) and a significantly higher number of Gram-negative bacteria than BC (77 versus 53, χ(2)=9.12; P=0.0025), as well as of polymicrobial infections (χ(2)=4.50, P=0.0339). In conclusion, SF combined with BC improved the diagnosis of sepsis, especially in immunocompromised patients.

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.

Quantification of hepatitis B surface antigen with the novel DiaSorin LIAISON XL Murex HBsAg Quant: correlation with the ARCHITECT quantitative assays.

BACKGROUND Recent technologic innovations allow for quantitative assessment of hepatitis B surface antigen (HBsAg) levels in serum; this has been used to monitor the course of chronic HBV hepatitis (CHB) and predict treatment response. LIAISON-XL Murex HBsAg Quant assay (DiaSorin, Saluggia, I) is the newest immunoassay CE approved to quantify HBsAg. OBJECTIVES To compare LIAISON-XL performances with ARCHITECT-QT HBsAg (Abbott Diagnostics, IL, USA), as reference test. STUDY DESIGN Sequential serum samples (n=152) from 14 HBe-negative patients with CHB, the majority of them infected by HBV genotype D undergoing antiviral treatment, were retrospectively tested with both assays. The 2nd WHO Standard 00/588 for HBsAg was used as reference. RESULTS LIAISON-XL and ARCHITECT-QT correlated by r=0.95, p<0.0001; by Bland-Altman analysis agreement of mean difference was 0.21 ± 0.15 log 10 IU/mL, 95% CI: -0.07 to 0.5). Performance of LIAISON-XL against the 2nd WHO Standard was r=0.998, p<0.0001 (95% CI: 0.993-0.999) with results nearer to the expected WHO values compared to ARCHITECT-QT. Median baseline HBsAg level was similar with the two methods before antiviral treatment, throughout fluctuations of HBsAg level in treatment non-responders and during the decrease of HBsAg titer in treatment responders. Correlation between HBsAg levels and HBV DNA was statistically significant for both the two immunoassays (LIAISON-XL: r=0.4988, 95% CI: 0.3452-0.6264, p<0.0001; ARCHITECT-QT: r=0.480, 95% CI: 0.3233-0.6111, p<0.0001). CONCLUSIONS Correlation between HBsAg measurement with LIAISON-XL and ARCHITECT-QT was high. LIAISON-XL accurately quantified HBsAg in clinical samples at baseline or during antiviral therapy; it can be applied for HBsAg quantification in clinical practice and decision making in CHB.

A(H1N1)pdm09 hemagglutinin D222G and D222N variants are frequently harbored by patients requiring extracorporeal membrane oxygenation and advanced respiratory assistance for severe A(H1N1)pdm09 infection

In patients with A(H1N1)pdm09 infection, severe lung involvement requiring admission to intensive care units (ICU) has been reported. Mutations at the hemagglutinin (HA) receptor binding site (RBS) have been associated with increased virulence and disease severity, representing a potential marker of critical illness.

Unmet Needs for a Rapid Diagnosis of Chikungunya Virus Infection

Rapid Diagnosis of Chikungunya Virus Infection

Effect of drug pretreatment on CBrCl3-induced liver injury☆

Abstract This study deals with the interaction of administered drugs with CBrCl3- induced toxicity. In vivo lipoperoxidation, fatty infiltration and necrosis of the liver were followed after poisoning with CBrCl3 in animals pretreated with phenobarbital, 2-diethylaminoethyl-2,2-diphenylvalerate (SKF-525A) or N, N′-diphenyl-p-phenylanediamine (DPPD). Double-bond shifting in liver microsomal lipids appeared to be enhanced by administration of barbiturate, whereas SKF-525A and DPPD lowered the extent of the peroxidative attack. Both hepatic triglyceride accumulation and leakage of liver enzymes (alanine aminotransferase [GPT] and aspartate aminotransferase [GOT]) into the plasma behaved similarly in the animals dosed orally with CBrCl3 (10 μl per 100 g body wt.). Lethality by CBrCl3 was reduced in rats pretreated with a small dose of CCl4 (25 μl per 100 g body wt.) which protects against an otherwise lethal dose of CCl4. In our opinion, this phenomenon indicates that the lethal effect of CBrCl3 also depends on the actual efficiency of the drug-metabolizing enzyme systems in the liver.

Mechanism of Protection Against Carbon Tetrachloride Toxicity. I. Prevention of Lethal Effects by Partial Surgical Hepatectomy

Both partial surgical hepatectomy and a challenge with a small dose of CCl4 depress the metabolism of xenobiotics in the liver. In fact, hepatocytes become provided with metabolic activity rates which are peculiar of either embryo or newborn rat liver. These experiments have shown that partial surgical hepatectomy prevents rats from death caused by otherwise lethal doses of CCl4. At the same time, sham-operated animals survive to a limited extent after a large dose of the halogen compound. Investigations carried out on the metabolic efficiency of liver microsomes, both in vito and in vivo, clearly demonstrate that the preventive effect against CCl4 depends mainly on the impaired metabolic activity of endoplasmic reticulum.

Toxicity of halogenated hydrocarbons in pretreated rats — an experimental model for the study of integrated permissible limits of environmental poisons

SummaryThe heavy use and the severe toxicity of several halogenocompounds render these pollutants very important agents in occupational and environmental pathology. Both the biological conditions and the environment by itself might influence their metabolism and then the degree of the resulting toxic effects.The present investigation extends the most significant parameters in toxicity studies to a number of largely diffused halogenocompounds, with special regard to a possible potentiation through the coexistence of other pollutants or by inducing treatments, such as isopropanol or phenobarbital administration.Chloroform by itself elicits toxic effects which are influenced by isopropanol challenge. Halothane and trichloroethylene appear devoid of any intrinsic poisonous action on the liver, and cause hepatic injury only in phenobarbital treated rats. In our experimental conditions, bromobenzene, fluobrene® and dichloromethane do not produce any detectable alteration in the liver. On the contrary, both isopropanol and phenobarbital render the rat particularly susceptible to the toxic effects of CCl4. In fact, treatment with alcohol reduces by two orders of magnitude the vapour concentration of the poison which causes liver necrosis and fatty infiltration, while dosing with barbiturate reduces to one tenth the effective dose of CCl4. which leads to fatty liver.These data underline the importance of the possible interaction between the halogenocompounds and the environmental factors or individual habits. Further, they clearly suggest the necessity of taking into account these experimental conditions in setting the maximum permissible limits (MAC or TLV) of halogenocompounds in the environment.