Laura Infurnari

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.

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.

Typhoid fever as a cause of opportunistic infection: case report

BackgroundTyphoid fever is a systemic infection caused by the bacterium Salmonella enterica subspecies enterica serotype typhi, which is acquired by ingestion of contaminated food and water. Each year the disease affects at least 16 million persons world-wide, most of whom reside in the developing countries of Southeast Asia and Africa. In Italy the disease is uncommon with a greater number of cases in Southern regions than in Northern ones.Case presentationWe report on a 57-year-old Sri-Lankan male affected by typhoid fever, the onset of which was accompanied by oropharyngeal candidiasis. This clinical sign was due to a transient cell-mediated immunity depression (CD4+ cell count was 130 cells/mm3) probably caused by Salmonella typhi infection. Human immunodeficiency virus infection was ruled out. Diagnosis of typhoid fever was made by the isolation of Salmonella typhi from two consecutive blood cultures. The patient recovered after a ten days therapy with ciprofloxacin and his CD4+ cell count improved gradually until normalization within 3 weeks.ConclusionOur patient is the first reported case of typhoid fever associated with oropharyngeal candidiasis. This finding suggests a close correlation between Salmonella typhi infection and transitory immunodepression.

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.