Paolo Gioannini

HIV infection acquired by a nurse.

We report here the history of the first case of occupationally acquired HIV infection in Italy.Results of serological investigations sequentially performed allow the investigators to outline the natural history of the infection in this case.

Coinfection and Superinfection of Hepatitis B Virus in Patients Infected with Human Immunodeficiency Virus: No Evidence of Faster Progression to AIDS

The influence of hepatitis B virus (HBV) on the natural history of human immunodeficiency virus (HIV) infection was evaluated in a prospective study of 347 HIV-positive, AIDS-free individuals infected through injecting drug use and sex and with known seroconversion dates. End points were CD4+ cell count < 200 x 10(6) cell/L and AIDS diagnosis. At entry, 229 had seromarkers to HBV; during the study, 107 had a CD4+ cell count < 200 x 10(6) cells/L and 66 developed AIDS. HBsAg chronic carriers, HBV infection-free subjects and those with baseline evidence of prior HBV infection did not differ in rates of progression to end points. Sexual transmission of HIV was significant predictor of CD4+ cell decline to < 200 x 10(6) cells/l [Hazard ratio (HZ): 1.56, 95% confidence interval (CI): 1.06-2.29, p = 0.0232] and progression to AIDS (HZ: 1.91, CI: 1.17-3.11, p = 0.0091). 15 HIV-positive and HBV infection-free patients had HBV seroconversion. They did not differ from those who remained HBV infection-free in rates of progression to end points, but 40% of them became HBsAg chronic carriers. These results suggest that HBV has no influence on progression of HIV disease, but that patients who have HIV before their HBV infection are more likely to become HBsAg chronic carriers than those who are infected with HBV before HIV.

Tracheobronchial aspergillosis in a patient with AIDS treated with aerosolized amphotericin B combined with itraconazole.

Summary. The clinical features of a tracheobronchial infection due to Aspergillus flavus in an AIDS patient with a normal neutrophil count is described. Diagnosis was made by culture and microscopic examination of biopsies obtained from bronchial vegetations seen at bronchoscopy. Radiographic examination of the neck revealed the presence of large endoluminal fungal masses. Initially the patient was treated with a combination of itraconazole, flucytosine and aerosolized amphotericin B, then only with itraconazole plus aerosolized amphotericin B. A good therapeutic response was observed.

Clarithromycin and Amoxicillin Susceptibility of Helicobacter pylori Strains Isolated from Adult Patients with Gastric or Duodenal Ulcer in Italy

Abstract.Helicobacter pylori strains, isolated from 100 gastric biopsies from 49 previously untreated adult patients with endoscopy and histology-confirmed gastric or duodenal ulcer, were tested for in vitro antimicrobial susceptibility. Strains were isolated from biopsies of 75.5% (37 of 49) patients before therapy and of 13.5% after therapy. Clarithromycin and amoxicillin susceptibility testing was performed on pretreatment and posttreatment strains by using the agar disk diffusion method and E-test, a quantitative technique for the minimal inhibitory concentration (MIC) determination. All strains (n = 53) were susceptible to amoxicillin by the two methods. Three strains of 34 (8.8%) patients were resistant to clarithromycin: two by both methods and one by E-test (MIC > 2 μg/ml). E-test, although more expensive than the disk diffusion method, is easy to perform and is a reliable method for testing H. pylori susceptibility to antimicrobial agents in the clinical microbiology laboratory.

Clinical and microscopical features of small-intestinal microsporidiosis in patients with AIDS.

SummaryIntestinal microsporidiosis byEnterocytozoon bieneusi is an increasingly recognized infection in AIDS patients. We report eight cases of microsporidiosis. All patients were severely immunodepressed. Clinical features were highly variable. Patients were followed up for a mean period of 7.8 months. All patients had persistent infection during the follow-up and spore excretion remained constant. Two patients became asymptomatic during the follow-up. None of the patients presented clinical and echographic signs of biliary involvement. Treatment with albendazole, metronidazole or paromomycin failed to produce a durable clinical response or to eradicate the organism. Cases were identified by stool examination and additionally investigated with light and electron microscopy. It was found that light microscopy was a sensitive method, while electron microscopy was less sensitive but allowed the definition of the infecting species. The modified trichrome stain was a satisfactory method for diagnosis on fecal smears. The calcofluor stain and the combination of DAPI with calcofluor was a rapid and simple staining method for screening.ZusammenfassungBei AIDS-Patienten werden mit zunehmender Häufigkeit Fälle von intestinaler Mikrosporidiose durchEnterocytozoon bineusi beobachtet. Wir berichten über 11 Mikrospordiosefälle. Bei allen Patienten bestand eine schwere Immundefizienz. Die klinische Symptomatik war sehr variabel. Die Patienten wurden im Mittel 7,8 Monate lang beobachtet. Alle Patienten hatten während der Beobachtungszeit eine persistierende Infektion und die Exkretion der Sporen blieb konstant. Zwei Patienten wurden während der Beobachtungszeit asymptomatisch. Bei keinem der Patienten bestanden klinische oder sonographische Zeichen für eine Beteiligung der Gallenwege. Die Therapie mit Albendazol, Metronidazol oder Paromomycin führte nicht zu einer bleibenden klinischen Besserung oder Erregereradikation. Die Diagnostik erfolgte durch Stuhluntersuchung unter Anwendung von Licht- und Elektronenmikroskopie. Die Lichtmikroskopie erwies sich als empfindliche Methode. Die Elektronenmikroskopie war weniger empfindlich, erlaubte jedoch die Spezifizierung des Erregers. Eine modifizierte Trichrom-Färbemethode war für die Beurteilung von Stuhlausstrichen brauchbar. Die Calcofluor-Färbung und die Kombination von DAPI mit Calcofluor erlaubte eine rasche und einfache Beurteilung für das Screening.

Meningoencephalitis caused by Toxoplasma gondii diagnosed by isolation from cerebrospinal fluid in an HIV-positive patient.

Toxoplasmosis of the central nervous system is a frequent opportunistic infection in AIDS patients, usually presenting as a mass brain lesion detected by computerized axial tomography scanning or magnetic resonance imaging. A case of diffuse meningoencephalitis with no radiological evidence of brain lesions is described. Diagnosis was made by culturing cerebrospinal fluid (CSF) on THP1 cells where tachyzoites of Toxoplasma gondii were demonstrated after 8 days of incubation by both direct observation and immunofluorescence. CSF examination with culture should be considered in AIDS patients with neurological signs and symptoms but without radiological evidence of cerebral lesions.

Rapid diagnosis of malaria by use of fluorescent probes.

Malaria diagnosis relies on observation of parasites in blood smears and the Giemsa-stained thick blood smear (G-TS) is the reference test. Diagnosis by G-TS in low-density infections requires long periods of observation and experienced microscopists. Examination of Giemsa-stained thin smears enables more reliable differentiation of species but may miss low-grade infections. Fluorescent stains may offer an alternative technique. We compared the Giemsa technique with 4,6-diamidine-2-phenilindolo-propidium iodide (DAPI-PI) stainings in order to evaluate the time required for diagnosis. A Plasmodium falciparum-infected blood specimen was diluted to obtain concentrations ranging from 6192 to 24 parasites/microliters (p/microliter), and thin and thick smears were stained with the two methods. The DAPI-PI proved useful: parasites were easily recognized and their morphology was preserved in thin and thick smears. The method allowed more rapid evaluation of thin smears as compared with Giemsa staining and enabled recognition of parasites in case of low-level parasitemias. The DAPI-PI staining technique may acquire an important role in malaria diagnosis, especially in nonendemic countries where technicians are not experienced with G-TS; in developing countries, it could be used in epidemiologic surveys of populations with low-density parasitemias, for which it enables a fast examination of smears and possibly the identification of parasite species.

Relationship between circulating immune complexes, serum interferon and clinical features in sarcoidosis

In order to assess the importance of circulating interferons and immune complexes as hypothetical mediators of some immune derangements observed in sarcoidosis, we evaluated serum interferon and immune complex levels in 45 patients with active disease. In none of our patients could circulating interferon be detected, suggesting that an infectious (viral) etiology is very unlikely, and that a great difference exists between sarcoidosis and true autoimmune diseases. On the other hand, circulating immune complexes could be found in 64.4% of our patients. A good correlation could be found with disease stage and duration, but only with 67Ga lung scan among other activity indexes.

Legionella taurinensis, a new species of Legionella isolated in Turin, Italy.

Lo Presti et al. (1999) reported in their article the description of a new Legionella species, Legionella taurinensis. We think it useful to provide some information about the origin of the type strain of this new species. The type strain reported as Turin I no. 1T (ATCC 700508T) and the strains Turin I no. 2, Turin II no. 180 and Turin II no. 195 of the ‘Turin cluster ’ have been isolated in our laboratory, the Infectious Diseases Institute of Turin, University of Turin (Legionella Reference Center for Piedmont Region) in March 1988 (Director Professor Paolo Gioannini) from a water sample of an oxygen bubble humidifier. The specimens were collected in a big university hospital (1850 beds) in Turin, where nosocomial Legionella infection occurred.

Effect of erythromycin on the immune response and interferon production

The influence of erythromycin on some aspects of humoral and cell-mediated immunity has been examined employing human as well as murine models, both in vivo and in vitro. No significant differences in antibody synthesis, alpha- and gamma-interferon yield, cutaneous delayed hypersensitivity or lymphocyte blastogenic response to mitogens have been detected between erythromycin-treated subjects and controls. Similarly, in vitro tests on interferon production and blastogenic response to mitogens showed no significant differences when performed with and without erythromycin. Therefore, in contrast with many other antibacterial drugs, erythromycin seems to be devoid of any adverse effects on the immune system.