Paolo Carfagna

Plasminogen Activator Production in a Rat Model of Pneumocystis carinii Pneumonia

Several studies have indicated that the serine protease urokinase‐plasminogen‐activator (uPA) is an important factor in host defense against pulmonary pathogens. To gain a better insight into the role of uPA in Pneumocystis carinii (P. carinii) pneumonia (PCP), we evaluated PA production in alveolar macrophages (AMs) obtained from rats with steroid‐induced PCP. Treatment with cortisone acetate favored PCP in 91% of rats. In the bronchoalveolar lavage (BAL) samples of immunosuppressed rats both with and without PCP, we observed a decrease in uPA activity as well as a decrease in cell number. Urokinase‐PA production by AMs was reduced in rats treated with cortisone alone. However, an increase in cell‐associated uPA was observed in rats with PCP. This increase appears to be produced in response to P. carinii infection. In fact, when AMs obtained from untreated healthy or immunosuppressed uninfected rats were challenged with P. carinii, a significant increase in PA activity in cell lysates was observed, though a lower response was obtained in cortisone‐treated animals. Our results suggest that healthy AMs respond to the presence of P. carinii with an increase in uPA production and that this response in immunodepressed rat‐AMs is partially impaired.

Arthritis as a rare side effect of phenytoin therapy

Anticonvulsant hypersensitivity syndrome is an uncommon side effect of phenytoin. It is characterized by fever, skin reactions, lymphadenopathy, and severe multiorgan involvement. Atypical clinical features have rarely been described. We observed a unique case of anticonvulsant hypersensitivity syndrome in a 77-year-old woman in whom fever and monoarthritis were the main clinical features. Symptoms dramatically subsided after phenytoin withdrawal.

STAPHYLOCOCCUS AUREUS MEININGITIS IN NEUROSURGERY ADULT PATIENTS: RETROSPECTIVE CLINICAL AND MICROBIOLOGIC ANALYSIS

We reviewed 12 cases of Staphylococcus aureus meningitis occurring over a 5-year period in five neurosurgery divisions at the Policlinico Umberto I. Six patients had an intraventricular shunt, five had craniotomy, and one had spinal surgery. All patients had one or more underlying causes other than surgery that might have predisposed to infection. Clinical presentation and cerebrospinal fluid (CSF) laboratory findings did not distinguish this form of meningitis from other acute bacterial meningitides. Gram stain of centrifuged CSF showed gram-positive cocci in 83% of cases. Blood cultures were positive in 25% of cases. Overall mortality was 50%. Eight CSF isolates were simultaneously resistant to oxacillin and rifampicin. Six of 10 patients treated with a glycopeptide were cured or improved. The remaining two patients with an oxacillin-susceptible S. aureus infection were cured: one was treated with cefamandole, the other one with ciprofloxacin and rifampicin.

Urokinase Plasminogen Activator and TGF-β production in Immunosuppressed Patients with and without Pneumocystis carinii

Pnewnocysris carinii infection is the most frequent complication in AIDS patients and alveolar macrophages (AM) play a significant role in the clearance of P. carinii from the lung by binding. phagocytizing and degrading the offending organism [5]. Several studies indicate that mkinase plasminogen activator (uPA) and transforming growth factor p (TGF-8) are impatant factors in host defense against pulmonary pathogens. Urokinase PA is a serine protease that converts plasminogen to the active enzyme plasmin. and appears to play a role in the n m a l functicming of the immune response. In fact. using transgenic mice lacking the uPA gene it has been demonstrated that uPA is required for the pulmonary inflammatory response to P . carinii [4]. TGF-p is secreted by different cell types as an inactive complex and then activated by proteolysis with release of active TGF-P from the complex. Activated mouse peritoneal macrophages are capable of activating endogeneous latent TGF-b when stimulated with U S : this process depends u p the presence of uPA and plasmin. Active TGFp. in turn. reduces uPA production and induces PAI production [7]. Several evidences suggest a role for TGF-P in HIV replication [8] and P. carinii clearance [9]. Therefore the aim of this study was to assess the production of uPA and TGF-P in H W and immunodepressed patients with and without P. carinii.

Cerebral abscesses due to methicillin-resistant Staphylococcus aureus complicating stroke

Abstract A 76-year-old man suffered a stroke with global aphasia and right hemiplegia. The ischemic infarction was demonstrated by computed tomography. After 2 months, multiple brain abscesses developed at the site of the original infarction. Blood and abscess aspiration cultures yielded a methicillin-resistant Staphylococcus aureus (MRSA). Infection was probably caused by hematogenous dissemination from aspiration pneumonia. Secondary localization in a previous hemorrhage or infarction area, as a consequence of a bloodstream infection, is rarely documented, with only a few cases reported in the medical literature. To our knowledge, this is the first case with this antibiotic-resistant organism.