Paola Cipriani

Prevalence of Chlamydia pneumoniae in peripheral blood mononuclear cells in Italian patients with acute ischaemic heart disease.

Chlamydia pneumoniae infection generally starts in the respiratory tract and probably disseminates systemically in the blood stream within alveolar macrophages. We investigated the prevalence of C. pneumoniae DNA in peripheral blood mononuclear cells (PBMC) in patients with acute ischaemic heart disease. Samples of blood were obtained from 93 consecutive patients with acute ischaemic heart disease and from 42 healthy subjects, for detection of C. pneumoniae DNA in PBMC by polymerase chain reaction (PCR) and for serology. C. pneumoniae DNA in PBMC was detected in 25.8% (24/93) of the patients with acute ischaemic heart disease and in 4.8% (2/42) of the healthy subjects (P=0.008). C. pneumoniae IgG was found in 76.3% of patients and in 45.2% of healthy subjects (P=0.0008) while C. pneumoniae IgA was found in 59.1% and in 33.3%, respectively (P=0.01). No correlation was found between anti-C. pneumoniae antibody titers and positive PCR results. The detection of C. pneumoniae DNA in PBMC may aid in selecting patients who may benefit from antibiotic treatment; however, to support this contention, longitudinal studies on patients treated with antibiotics would also be necessary.

Chlamydia pneumoniae and atherosclerosis: current state and future prospectives.

Chlamydia pneumoniae, an intracellular bacterial pathogen, is known as a leading cause of human respiratory tract infections worldwide. Over the last decade, several reports in the literature have suggested that infection with C. pneumoniae may contribute to the pathogenesis of atherosclerosis. In order to play a causative role in chronic disease, C. pneumoniae would need to persist within infected tissue for extended periods of time, thereby stimulating a chronic inflammatory response. C. pneumoniae has been shown to disseminate systemically from the lungs through infected peripheral blood mononuclear cells and to localize in arteries where it may infect endothelial cells, vascular smooth muscle cells, monocytes/macrophages and promote inflammatory atherogenous process. The involvement of C. pneumoniae in atherosclerosis was investigated by seroepidemiological and pathological studies, in vivo and in vitro studies, and in clinical antibiotic treatment trials. This review will provide an update on the role of C. pneumoniae in atherosclerosis focusing on the recent insights and suggesting areas for future research.

Endocarditis caused by Lactobacillus jensenii in an immunocompetent patient.

Lactobacilli are Gram-positive rod-shaped bacteria that inhabit the oral cavity, gastrointestinal tract, vagina and nasal cavity. In this report, a rare case of Lactobacillus jensenii endocarditis in a 47-year-old immunocompetent patient is described. Blood cultures and a replaced mitral valve were positive for L. jensenii as assessed by 16S rRNA gene sequencing. Based on susceptibility tests the patient was successfully treated with a mixture of teicoplanin and meropenem antimicrobial therapy.

Pyrolysis of automotive shredder residues: a lumped kinetic characterization

A lumped kinetic model for the pyrolysis of industrial wastes of unknown chemical composition is developed. The model is applied to the pyrolysis of automotive shredder residues (ASRs), studied by means of thermogravimetric and calorimetric analyses, in isothermal and non-isothermal conditions.

Chlamydia pneumoniae and chronic diseases with a great impact on public health.

Chlamydia pneumoniae is recognised as a common cause of respiratory tract infections and has recently been implicated in several extrapulmonary chronic diseases, with great impact on public health, such as atherosclerosis, multiple sclerosis and Alzheimers disease. The involvement of C. pneumoniae in such diseases may be correlated to characteristic features of this pathogen, including intracellular growth and ability to induce persistent forms. C. pneumoniae persistent forms are inherently more suited to evade the host immune response and are more difficult to eradicate by antibiotics. Our preliminary experimental findings show that interaction of C. pneumoniae with macrophages and/or T cells characterized by interference with TNF-α production, and redox state, culminates in the induction of T cell apoptosis and survival of infected macrophages. Based on our evidence, the poor cooperation between T cells and macrophages could lead to an inappropriate immune response against C. pneumoniae that may therefore promote the development of extrapulmonary chronic diseases.

Burkholderia cenocepacia Vaginal Infection in Patient with Smoldering Myeloma and Chronic Hepatitis C

We report a case of a vaginal infection caused by a strain of Burkholderia cenocepacia. The strain was isolated from vaginal swab specimens from a 68-year-old woman with smoldering myeloma and chronic hepatitis C virus infection who was hospitalized for abdominal abscess. Treatment with piperacillin/tazobactam eliminated B. cenocepacia infection and vaginal symptoms.

Purification of ε-caprolactam by means of a new dry-sweating technique

A new dry-sweating technique, based on the use of a centrifuge was applied to purify solid particles of e-caprolactam. It allows elimination of up to 80% of the organic impurities with a relatively low molten mass, between 20 and 30%. Experimental runs were carried out on specifically produced solid pastilles and solid particles of industrial material. On the basis of the achieved results, a mechanism of the dry-sweating process is proposed.

Genotyping of different Pseudomonas aeruginosa morphotypes arising from the lower respiratory tract of a patient taken to an Intensive Care Unit.

Pseudomonas aeruginosa is an opportunistic pathogen and an ubiquitous environmental bacterium. Fifty-seven days after hospitalization, we isolated three distinct P. aeruginosa morphotypes (smooth, rough and mucoid) from the lower respiratory tract of a patient admitted to a Cardiology Intensive Care Unit (ICU). Moreover, a group of nine colony variants, arising from the three P. aeruginosa isolates growing in laboratory growth media, were also isolated. The resulting 12 isolates were characterised for antibiotic resistance profile and subjected to genotypic analysis by fluorescent-Amplified Fragment Length Polymorphism (f-AFLP) and automated repetitive extragenic palindromic-PCR (rep-PCR) fingerprinting. The three smooth, rough and mucoid morphotypes presented different antibiotic resistance profiles and genotyping analysis showed that they belonged to distinct clones, indicating that at day 57 after the admission the patient was simultaneously colonized by three distinct P. aeruginosa isolates. On the other hand, the nine colony variants presented heterogeneous antibiotic resistance profiles and clustered together with the three parental isolates. The understanding of the link between genotype plasticity and antibiotic resistance may contribute to improving our knowledge of this life-threatening pathogen.

Is management with lamivudine always the appropriate choice for HBV patients with onco-hematologic diseases?

Dear Editor, We read with interest the article by Yi-Fu H. et al. [1] about the effectiveness of Lamivudine (LAM) prophylaxis in preventing hepatitis B viral (HBV) reactivation in Rituximab containing regimens (so called immunochemotheraphy, ICT) for lymphoma and would like to make a contribution to this emerging topic. All patients diagnosed with Non-Hodgkin Lymphoma (NHL) from January 2005 to March 2008, at our Institution, were screened for HBV serology: HBsAg, anti-HBs, anti-HBc, HBeAg, anti-HBe. Patients were also tested for HCV antibodies (HIV-positive patients were not included): 18 out of 159 patients (11.3%) had serological signs of HBV exposure. 12 out of 159 (8.1%) patients were HCV-infected. Seven out of 18 HBV carriers were coinfected with HCV (38.8%). In 11 out of 18 patients (61%), HBsAg were negative [2], anti-HBc (nine patients), anti-HBs (one patient, no history of previous vaccination), anti-HBc/anti-HBe/anti-HBs (one patient) being the only positive markers of previous HBV exposure. Three patients were known to be affected by mild HBV chronic active hepatitis at the time of lymphoma diagnosis and were treated with LAM to contain the disease process before and after ICT. The remaining four inactive HBsAg carriers and the 11 HBsAg-negative/antiHBc-positive patients were started on LAM as a preemptive treatment to prevent possible disease reactivation [3]. Patients began treatment with LAM 100 mg/day po on average 3–4 weeks before embarking on chemotherapy, after signing informed consent. All 159 patients were given R-CHOP or R-CHOP-like regimens [4]. LAM treatment was extended to 18 months after that the new indications from the dedicated commission of the Italian Study of the Liver became widely available in 2007 [3]. During and after ICT discontinuation, patients were tested every 2 months for HBsAg, quantitative-HBV-DNA, ALT, and AST. Median follow-up time was 7 months (range 3–43). Five of the seven HBsAg-positive patients (71.4%) became HBV-DNA positive during follow-up at 25, 18, 18, 10, and 7 months after commencing LAM. In two patients, emergence of HBV-DNA positivity was associated with an increase of serum transaminases (up to five times the upper normal limit). In these five patients, AdefovirDipivoxyl, 10 mg/day po, was combined with LAM, resulting in a disappearance of HBV-DNA and regression of the biochemical signs of hepatitis. None of these patients had to discontinue ICT because of HBV reactivation. No liver-related deaths occurred. None of the HBcAbpositive, anti-HBs-positive/HBsAg-negative patients (potential silent carriers) developed HBV reactivation during the period of observation. No side effect related either to LAM or ADV was registered. Four out of seven of these patients are now undergoing new treatments because of lymphoma progression. The prevalence of HBV infection is high among patients diagnosed with NHL as compared to less than 2% of the Italian adult population [5]. Reactivation of HBV infection can present a serious threat to these patients and to the Ann Hematol (2009) 88:283–284 DOI 10.1007/s00277-008-0609-2

Opsonic activity of intravenous immune globulin on Gram-negative bacteria exposed to a monobactam antibiotic

Abstract Sub-inhibitory concentrations of antibiotics can alter the morphology and structure of the bacterial surface leading to better opsonization and therefore enhanced phagocytosis. The opsonic activity of a standard intravenous immune gamma globulin (IVIG) was tested for control bacteria and bacteria grown in the presence of sub-minimal inhibitory concentration (sub-MIC) of aztreonam, and β-lactam antibiotic. IVIG enhanced uptake by polymorphonuclear leucocytes of five Gram-negative bacteria. This enhancement was further increased when bacteria were exposed to sub-MIC of aztreonam.