Romualdo Grande

Chagas disease in Europe: A review for the internist in the globalized world

Chagas disease (CD) or American trypanosomiasis identified in 1909 by Carlos Chagas, has become over the last 40years a global health concern due to the huge migration flows from Latin America to Europe, United States, Canada and Japan. In Europe, most migrants from CD-endemic areas are concentrated in Spain, Italy, France, United Kingdom and Switzerland. Pooled seroprevalence studies conducted in Europe show an overall 4.2% prevalence, with the highest infection rates observed among individuals from Bolivia (18.1%). However, in most European countries the disease is neglected with absence of screening programmes and low access to diagnosis and treatment. Physicians working in Europe should also be aware of the risk of autochthonous transmission of Trypanosoma cruzi to newborns by their infected mothers and to recipients of blood or transplanted organs from infected donors. Finally, physicians should be able to recognize and treat the most frequent and serious complications of chronic Chagas disease, namely cardiomyopathy, megacolon and megaesophagus. This review aims to highlights the problem of CD in Europe by reviewing papers published by European researchers on this argument, in order to raise the awareness of internists who are bound to increasingly encounter patients with the disease in their routine daily activities.

An unusual febrile nonhemolytic reaction occurred after transfusion in a thalassemia major patient with asymptomatic Plasmodium falciparum infection

BACKGROUND: Febrile nonhemolytic transfusion reactions occur in 0.12% of transfusions, usually during transfusion or within 4 to 6 hours after transfusion and are not medically dangerous.

Intracytoplasmic hemozoin (malarial pigment) in a case of severe, aparasitemic Plasmodium falciparum malaria.

A 17-year-old girl from Togo with a β-thalassemia maior was seen at an emergency department with high fever, coma, and severe anemia (Hb < 3 g/dL). No malaria parasites were found on thin film and thick smears in the first few days of the infection. Despite the failure to observe Plasmodium intraerythrocytic forms in the bloodstream, many white blood cells showed brown, birefringent, intracytoplasmic inclusions (thick arrows) consistent with malarial pigment (hemozoin).The detection of intraleucocytic hemozoin with a negative malaria smear has to be considered as strongly suggestive of Plasmodium falciparum infection1 (Figure 1). Additional blood specimens were analyzed by a pan-human Plasmodium polymerase chain reaction and resulted positives. Further thin films and thick smears were prepared from fingerprick and venipuncture the next day, and they showed visible intraerythrocytic rings. The patient was treated with IV quinine and recovered completely. Figure 1. Intracytoplasmatic hemozoin granules (arrow) Giemsa thin films (100× magnification).

A case of Histoplasma capsulatum endophthalmitis diagnosed in Italy

Histoplasma capsulatum var. capsulatum is a dimorphic fungus endemic in the eastern United States and most countries of Latin America. Sporadic cases of histoplasmosis have been reported in Europe, mainly in immigrants or people returning from highly endemic areas. We report a case of 64-year-old Italian man with endophthalmitis, an unusual presentation of H. capsulatum infection. The patient shows redness, blurred vision, localized pain in the right eye. H. capsulatum was cultured from a vitreous biopsy and yeast forms were seen at histology.

Epidemiological and clinical characteristics of imported malaria in adults in Milan, Italy, 2010–2015

Correspondence to: Prof. Spinello Antinori Luigi Sacco Department of Biomedical and Clinical Sciences Università degli Studi di Milano Via GB Grassi 74, 20157 Milano , Italy Tel. +390250319765 Fax +390250319758 E-mail: spinello.antinori@unimi.it Investigators of the Malaria Study Group: Laura Galimberti 2 , Letizia Oreni 2 , Sara Schinaia 2 , Laura Milazzo 2 , Massimo Galli 1,2 , Mario Corbellino 2 , Maria Rita Gismondo 3 , Nadia Zanchetta 3 , Laura Cordier 4 , Giuliano Rizzardini 4

Diagnosis of Louse-Borne Relapsing Fever despite Negative Microscopy in Two Asylum Seekers from Eastern Africa

We report two cases of louse-borne relapsing fever observed at our Institution in June 2016. Both patients were young asylum seekers from Africa who had recently arrived in Milan, Italy. Notably, direct microscopic examination of peripheral blood smears was repeatedly negative for the presence of spirochetes and the diagnosis, supported by clinical and epidemiologic evidence, required molecular confirmation by polymerase chain reaction amplification of DNA extracted from blood and sequencing of the amplified products.

Amebic colitis in Italy after Christmas

After spending his Christmas holidays in Egypt, a 54-year-old usiness man living in Milan was referred to us because of hemaochezia in March 2011. Colonoscopy revealed ulcers in the right olon (arrow, Fig. 1) and the rectum; the mucosa between the ulcers ad a normal appearance. Histological examinations of colonic iopsies revealed a normal mucosal architecture with increased umber of eosinophils in the submucosa (arrows, Fig. 2a); no parsites were found. However, serum anti-amoeba antibody levels ere high, and the parasite was finally found upon direct stool xamination and cultured in Robinson’s medium. Fig. 2b shows wo chromatoidal bodies (arrows) with the elongated shape and lunt, rounded edges typical of a protozoal cyst. Isoenzymatic charcterisation identified an Entamoeba histolytica as zymodeme II. The atient was successfully treated with tinidazole 2 g for five days ollowed by paromomycin 1.4 g for seven days.

Shigella flexneri-induced vaginitis in a prepubertal children: description of a case

In prepuberal girls vulvo-vaginitis are caused by germs of intestinal origin,mycetes, Gardnerella vaginalis, protozoa. Shigella is an uncommon agent able to induce valvovaginitis in children. We report the case of a 7-year-old girl with chronic vulvo-vaginitis caused by S. flexneri. Antibiotic Susceptibility Testing revealed that S. flexnery was sensible to cefotaxime, amoxicillin, imipenem, ciprofloxacin, but resistant to amikacin, cefazolin, gentamycin, ampicillin and tetracycline. A treatment with ciprofloxacin brought to a rapid resolution of all symptoms. At the follows up at 3 and 6 months the patient did not report symptoms of infection or articular cartilage abnormality; microbiological evaluations were also negative. Even if it is a single case report and other clinical trial may be performed in order to validate this hypothesis,we speculate that in patient with vulvo-vaginal infection living in environment with low hygiene care, a carefully microbiological evaluation of uncommon agents may be performed.