Mario Rassu

Changing epidemiology of HCV and HBV infections in Northern Italy: a survey in the general population.

Aim To evaluate the hepatitis B virus (HBV) and the hepatitis C virus (HCV) epidemiology in the general population of Northern Italy, a cohort of 965 subjects, all residents (including 47 immigrants), were anonymously tested for HBV and HCV infections. Material and Methods Serum samples were assayed for anti-HCV and anti-HBV markers by enzyme-linked immunosorbent assay and for HCV-RNA by polymerase chain reaction, and the positive cases were genotyped. HBsAg-positive cases were assayed for HBeAg/anti-HBe, whereas HBsAg negatives were tested for both anti-HBc and anti-HBs. Results The overall prevalence of anti-HCV was 2.6%, with a bimodal distribution characterized by the highest prevalence (12%) in subjects over 75 years old. None of the subjects under 25 years old was anti-HCV positive. Anti-HCV positivity was similar in males and females (2.4% vs. 2.7%). HCV-RNA was positive in 40% of cases and genotype 1 was the most common. The HBsAg prevalence was 1%, with a significant difference according to country of origin (0.8% in Italian subjects vs. 6.4% in immigrants, P=0.01). HBsAg positivity increased significantly with age (R2=0.57, P<0.02). The overall percentages for the prevalence of isolated anti-HBs, anti-HBs+/anti-HBc+, and isolated anti-HBc were 23.8%, 8.4%, and 4.2%, respectively. Conclusions Our study provides a new picture of HCV and HBV epidemiology in Northern Italy, with these features: (1) a cohort effect showing a reduction of HCV infection in the elderly, possible due to age-related mortality; (2) an unchanged overall prevalence of HBV infection, despite continuing immigration of subjects from endemic countries.

Rapid detection of Paenibacillus larvae from honey and hive samples with a novel nested PCR protocol

The bacterial pathogen Paenibacillus larvae is the causative agent of American foulbrood disease in honeybees (Apis mellifera). A touchdown nested PCR protocol was developed to detect the presence of P. larvae spores directly in honey and hive samples. This approach allows early discovery of the bacteria even at concentrations below pathogenic levels, opening the door to new prophylactic approaches against American foulbrood and real-time epidemiological studies.

Investigation of a Q-fever outbreak in Northern Italy

AbstractObjectives: A study was conducted to evaluate the extent of a Q-fever epidemic through active case finding in the area of Vicenza (northeastern Italy), and to identify risk factors for Q-fever in this outbreak. Methods: 1) Descriptive epidemiology; 2) Seroepidemiological survey; 3) Case-control study. 1) Epidemic curve and maps with the location of cases. Identification of the road followed by the flocks of sheep. 2) Cross-sectional study on humans and flocks of sheep tested for anti-Coxiella burnetii antibodies. 3) Cases were defined by the presence of fever > 38 °C plus serological confirmation. Controls were 94 apparently healthy individuals attending outpatient facilities for control visits or certification, group-matched by geographical area, age and gender. A standardized questionnaire was administered by trained interviewers. Odds ratio and 95% confidence intervals (CI) were used to evaluate risk factors for Q-fever. Results: A total of 58 cases were identified in a 5-month period. Male to female ratio was 2.8:1; mean age was 42 years (range: 20–65 years). Twenty-eight patients (48%) were hospitalized. Fever was accompanied by asthenia (81%), headache (76%), chills (72%), and myalgia and arthralgia (53%); cough was present in 47% of patients. Rx abnormalities were found in 81 % of the patients undergoing chest X-ray. Among 111 apparently healthy family members who underwent serological testing, four (3.6%) had antibodies to Coxiella burnetii. Three flocks which passed through the outbreak area between late May and early June were shown to be infected, with prevalence of antibodies ranging between 45 and 53%. The case-control study showed a significant association with exposure to flocks of sheep (Odds ratio = 6.1; 95% CI 2.5, 16.3). Other potential risk factors were not more commonly reported by cases with respect to controls. Conclusions: Indirect exposure to flocks of sheep was a determinant of this outbreak of Q-fever. This finding suggests that transmission occurred through inhalation of contaminated airborne particles. The importance of control measures should be stressed in areas traversed by flocks of sheep.

Efficacy of 7 day lansoprazole-based triple therapy for Helicobacter pylori infection in elderly patients.

Background: The prevalence of Helicobacter pylori increases with age. However, data regarding the effects of anti‐H. pylori treatments in the elderly are very scarce.

In vitro activity of rifabutin against strains of Helicobacter pylori resistant to metronidazole and clarithromycin

In vitro activity of rifabutin against strains of Helicobacter pylori resistant to metronidazole and clarithromycin

Detection of Chlamydophila pneumoniae DNA in peripheral blood mononuclear cells of blood donors in the north-east of Italy

Abstract. Recent studies have implicated Chlamydia pneumoniae (now Chlamydophila pneumoniae) in the pathogenesis of atherosclerosis and demonstrated its presence within human peripheral blood mononuclear cells (PBMCs). In this study the presence of C. pneumoniae DNA was assessed, using nested PCR, in PBMCs from 169 active blood donors as a function of age, of specific antibodies and C-reactive protein. The results obtained demonstrated a high degree of global positivity (46.15%), which was higher in females (52%) than in males (43.7%). Seroepidemiological studies showed a high percentage of positivity both in subjects positive by PCR (65.91%) and negative by PCR (71.74%). The clinical implication of such finding are under study.

Chlamydia pneumoniae infection in HIV‐positive patients: prevalence and relationship with lipid profile

The aims of this study were to evaluate the prevalence and impact of Chlamydia pneumoniae infection in HIV‐positive patients and to establish the relationship between C. pneumoniae infection and lipid profile.

Impact of liver steatosis on virological response in elderly Italian patients with chronic hepatitis C treated with peg-interferon alpha-2b plus ribavarin

Background : Whether liver steatosis affects sustained virological response in patients with chronic hepatitis C is still under discussion.

Triple therapy prevents HIV but not HCV transmission after needlestick injury.

TO THE EDITOR: Health care workers are at risk for acquiring both HIV and HCV infections through needlestick injury. Prophylactic treatments are now available for preventing HIV but not for preventing HCV infections after parenteral exposure (1, 2). The efficacy of protease inhibitors, used in combination with other antiretroviral drugs, in the treatment of HIV infection has been well documented and a triple therapy, including a protease inhibitor, is now recommended after parenteral exposure to blood from HIVinfected subjects (3). It has been postulated that proteases could represent a possible target also for the treatment of HCV infection (4, 5). However, despite improvement of immune status, it has recently been reported that HIV protease inhibitors do not seem to exert any effect on, or may even temporarily increase HCV viremia, in patients who are HCVand HIV coinfected (6). Up to now, the effect of the HIV protease inhibitors on HCV transmission after exposure either to blood or to other body fluids from HCV and HIV patients is unknown. We report here the case of a health care worker who developed acute hepatitis C after antiretroviral triple prophylaxis (including a protease inhibitor) performed after a deep injury with a small diameter needle (23 gauge) previously used in a patient coinfected with HCV and HIV. The source patient, a 30-yr-old man, was not receiving antiretroviral treatments at the time of the needlestick accident. He displayed a CD41 count and an HIV viral load (bDNAChiron assay; Chiron, Emeryville, CA) of 224 3 10 cells/L and 5 3 10 copies/ml, respectively. AST and ALT serum levels were 37 IU/L (normal value #40 IU/L) and 48 IU (normal value #45 IU/L), respectively. The health care worker was a 39-yr-old nurse who had had normal liver function and was seronegative for antibodies to HCV and HIV before and at the time of the needlestick accident. Half an hour after the injury, therapy with zidovudine (ZDV, 250 mg b.i.d.), lamivudine (3TC, 150 mg b.i.d.) and indinavir (IDV, 800 mg t.i.d.) was started. HIV prophylactic treatment was continued for 4 wk without any particular problems. Thirty-four days from the accident, a slight increase of transaminases was documented (AST 37 IU/L and ALT 52 IU/L, respectively). After a further week, the nurse started to complain of fatigue and anorexia, and a sharp increase in liver function tests was documented (AST 675 IU/L, ALT 850 IU/L). Both anti-HCV (Ortho Diagnostic systems) and HCV-RNA (Amplicor-Roche) became positive, whereas anti-HIV and HIV-RNA remained undetectable. HCV typing revealed a 3a genotype. A retrospective testing of a serum sample from the source patient stored at the time of accident revealed the same genotype; quantitative HCVRNA testing (bDNA2-Chiron assay, Emeryville, CA) revealed 439 3 10 Eq/ml. Because the nurse (after a peak observed after 1 month from the onset) displayed fluctuating ALT levels and her serum was persistently positive for HCV-RNA, treatment with recombinant alpha-2a IFN (Roferon A) was started at month 3 (6 MU every 48 h for 12 consecutive wk). Before starting IFN treatment, the HCVRNA viral load was 539 3 10 Eq/ml. ALT serum levels became normal after 1 wk of IFN treatment and HCV-RNA became negative after the first month of treatment. After 24 months from the IFN therapy cessation, ALT remains in the normal range, and both HCV-RNA and HIV-RNA are negative. This case report demonstrates that HCV transmission after a needlestick accident is strikly related neither to HCV viral titre nor to the diameter of the needle used. Moreover, our experience confirms the effect of triple therapy for preventing HIV, but excludes any effect of this therapy for preventing HCV transmission after needlestick injury. In addition, these data confirm the usefulness of early interferon therapy to prevent the development of chronic hepatitis C (7).