Giordano S

Asymptomatic Leishmania infantum/chagasi infection in blood donors of western Sicily

The purpose of this study was to evaluate whether the risk of transfusion-transmitted visceral leishmaniasis was present in an area of western Sicily where the incidence of the disease is higher than the regional average. From May to December 2005, 1449 blood donors from Agrigento district (Sicily, Italy) were screened for the presence of anti-Leishmania antibodies by an indirect immunofluorescent antibody test (IFAT). Blood samples from IFAT-positive donors were examined by PCR to detect Leishmania DNA. Anti-Leishmania antibodies were found in 11 (0.75%) cases, among which Leishmania DNA was detected from four (36.4%). Particular techniques to inactivate different pathogens would be considered mandatory in the case of immunosuppressed recipients.

Haemophagocytic syndrome and rickettsial diseases

Haemophagocytic lymphohistiocytosis is a rare but potentially fatal disease resulting from dysregulated activation and proliferation of lymphocytes. We present a case of haemophagocytic syndrome occurring in a 5-year-old Italian boy as a complication of Mediterranean spotted fever. The characteristics of this case have been analysed and contextualized among those of another 15 cases of haemophagocytic syndrome associated with rickettsial diseases found through a systematic review of the international literature.

Treatment of Human Brucellosis with Rifampin plus Minocycline

Abstract In order to evaluate the efficacy and tolerability of a high intravenous dose of rifampin plus oral minocycline (administered daily for 3 weeks) for the treatment of acute brucellosis, we retrospectively reviewed the outcome of 239 consecutive patients (135 adults and 104 children) diagnosed and treated over a 17-year period in Italy. The combination used resulted in 100% response and a relapse rate lower than 2%. Fifty-two (30 adults and 22 children) (29.8%) complained of mild adverse effects including an increase in aspartate aminotransferase (>250 IU) observed in 12 cases and considered related to rifampin and in 11 cases a reversible hyperpigmentation of the tongue attributed to minocycline. A randomized prospective comparative study should be performed to confirm our encouraging results.

Human toxocariasis: a report of nine cases.

Aim: Human toxocariasis is caused by infection with the larval stage of nematode parasites of dogs and cats, Toxocara canis or Toxocara cati. These helminths are not able to complete their life cycle in undefinitive hosts and so undergo aberrant migrations in the tissues causing a wide spectrum of signs and symptoms. Eosinophilia is often severe and sometimes represents the only sign of infection, except in ocular and neurological forms.

Secondary hemophagocytic lymphohistiocytosis: forget me not!

A. David, C. Iaria, S. Giordano, M. Iaria, A. Cascio. Secondary hemophagocytic lymphohistiocytosis: forget me not! Transpl Infect Dis 2012: 14: E121–E123. All rights reserved A. David, C. Iaria, S. Giordano, M. Iaria, A. Cascio Department of Neurosciences, Psychiatric and Anesthesiological Sciences, University of Messina, Messina, Italy, Infectious Diseases Unit–Azienda Ospedaliera Piemonte-Papardo, Messina, Italy, Unità Operativa Complessa di Malattie Infettive–ARNAS “Civico, Di Cristina, Benfratelli”, Palermo, Italy, Division of General Surgery and Organ Transplantation, Department of Surgical Sciences, Parma University Hospital, Parma, Italy, Department of Human Pathology, University of Messina, Messina, Italy

Extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacter cloacae ventriculitis successfully treated with intraventricular colistin

We present a case of post-neurosurgical ventriculitis caused by carbapenemase-producing Enterobacter cloacae successfully treated with intraventricular colistin. Enterobacter spp are intrinsically resistant to aminopenicillins, cefazolin, and cefoxitin due to the production of constitutive chromosomal AmpC beta-lactamases. Moreover, extended-spectrum beta-lactamase-producing Enterobacter spp have been identified in the USA and Europe, and carbapenems are considered the drug of choice in these cases. Our isolate was sensitive only to fosfomycin, tigecycline, and colistin, and 6 days of intravenous colistin had failed to eradicate the infection. This case provides clinical evidence to support the administration of intraventricular colistin in such patients.

Visceral leishmaniasis in a patient with Down syndrome

Visceral leishmaniasis (VL) due to Leishmania infantum is a vector-borne zoonotic disease endemic in Sicily. We report on a case of VL that occurred in a child with a cardiopathic condition and Down syndrome. In January 2005 a 6-month-old child with Down syndrome underwent a surgical intervention for congenital cardiopathy. Two months later the child returned to the paediatric cardiosurgery department with a 5-day history of fever. At admission, the patient was febrile, pale, with rare petechial lesions. A greatly enlarged and hard spleen was observed. Laboratory examination revealed pancytopenia and high gammaglobulin value. An immuno-fluorescence antibody test (IFAT) for Leishmania spp. detected the presence of anti-Leishmania antibodies. Bone marrow microscopy and polymerase chain reaction (PCR) revealed the presence of Leishmania parasites. Treatment with intravenous liposomal amphotericin B at a dose of 3 mg/kg per day was administered for 10 consecutive days. Defervescence was obtained after 3 days of treatment. At the end of therapy splenomegaly and hepatomegaly were reduced, haematological values were improved and anti-Leishmania antibodies (by IFAT) were undetectable. To our knowledge this is the first reported case of VL in a patient with chromosome 21 trisomy. Down syndrome is associated with different immune dysfunctions, which have been correlated to a general predisposition to infection [2, 4, 6]. Moreover, our patient was convalescent from major surgery, and this might have lead to further immuno-deficiency. In spite of these aggravating factors the patient showed a typical clinical presentation and recovered in a way that any child with immuno-competence would normally recover. Undoubtedly, early diagnosis had an important role in the good outcome of the disease in our patient. The proven efficacy of liposomal amphotericin B in immunodeficient subjects [3, 5] and the lack of cardiac side effects, already reported in a patient with Down syndrome treated with meglumine antimoniate [1], are the most important advantages of this therapy, especially in a patient with a cardiopathic condition. In conclusion, we stress the need for the paediatrician to consider VL in Down syndrome children living in endemic areas so as to avoid misdiagnosis (immunological or neoplastic diseases) and, consequently, the wrong treatment, such as steroid therapy, which would make worse the clinical course of leishmanial infection.