Ruggiero D'Elia

HIV: mother to child transmission current knowledge and on-going studies.

It is estimated that approximately 6000 women of childbearing age, mostly living in the developing world, acquire HIV infection every day. Taking into account that approximately 98% of HIV infected children have acquired HIV from the mother, during pregnancy, at delivery or through breastfeeding, therefore, prevention of mother‐to‐child transmission (MTCT) is a major health priority. Several studies have showed how MTCT of HIV may be prevented using antiretrovirals. Results from a study conducted in Thailand have also recently showed how a short oral zidovudine course during pregnancy and labor may reduce the risk of HIV transmission by approximately 50%. These findings represent a major challenge for the International Health Agencies and Organizations that will have the major obligation to provide HIV tests, counseling and antiviral drugs in settings with high HIV prevalence.

The use of antibiotics in the treatment and prevention of infection in HIV-infected children.

Children with HIV infection have an unusual susceptibility to bacterial infection, related to several immune abnormalities. Selection of initial antibiotic therapy must be individualized in these children. Patients with community‐acquired disease are most likely to have infection by polysaccharide‐encapsulated bacterial organism, most commonly Streptococcus pneumoniae and less frequently by Haemophilus influenzae type b. If it is possible to treat the patients at home, the use of amoxicillin‐clavulanic acid might be appropriate. Other authors propose management with parenteral ceftriaxone because of the better compliance and the malabsorption. In hospitalized patients, concern for Gram‐negative enteric pathogens other than polysaccharide‐encapsulated organisms requires initial therapy with a third‐generation cephalosporine in combination with an aminoglycoside. Trimethoprim‐sulfamethizole is the most common drug used in HIV‐infected children because it is recommended for the initial therapy and for prophylaxis of Pneumocystis carinii pneumonia, which occurs in as many as 42% of these children.

Absence of maternal antibodies to hepatitis B core antigen and HBV vertical transmission: One case of infection notwithstanding passive-active prophylaxis

SummaryWe report the case of a newborn of an HBsAg carrier mother who was infected by vertical transmission and developed a subclinical hepatitis B at four months of age, notwithstanding the passive-active prophylaxis performed right after birth. The mothers HBV marker status was: HBsAg positive, HBeAg positive, anti-HBc IgM positive at low titer, anti-HBc IgG negative, anti-HBs negative, anti-HBe negative. It is assumed that the absence of anti-HBC antibodies might have favoured, perhaps in utero, the HBV infection whose antigenic expression was subsequently delayed by HBIg administered at birth. These findings suggest that the positivity for anti-HBc IgM must be considered an additional marker of maternal infectivity especially in the absence of anti-HBc IgG antibodies.ZusammenfassungWir berichten über das Neugeborene einer Mutter mit HBsAg-Trägerstatus, das durch vertikale Übertragung infiziert wurde und im Alter von vier Monaten trotz der sofort nach Geburt durchgeführten aktiv-passiven Impfprophylaxe eine subklinische Hepatitis B entwickelte. Bei der Mutter wurde folgender HBV-Marker-Status nachgewiesen: HBsAg-, HBeAg-positiv; niedrige Titer von anti-HBc IgM, anti-HBc IgG-, anti-HBs- und anti-HBe-negativ. Es wird angenommen, daß das Fehlen von anti-HBc-Antikörpern die möglicherweise in utero erfolgte HBV-Infektion begünstigt hat, deren antigene Expression anschließend durch die Gabe von HBIg bei Geburt verzögert wurde. Aus diesen Befunden ist zu schließen, daß der Nachweis von anti-HBc IgM, insbesondere bei Fehlen von anti-HBc IgG-Antikörpern, ein zusätzlicher Marker für mütterliche Infektiosität ist.

A new screening test for rotavirus infection.

SummaryA simple and rapid staphylococcal coagglutination test, using rabbit antisera prepared against Nebraska calf diarrhea virus (NCDV), is described for the detection of rotavirus in neonatal fecal specimens. When the samples were examined directly using the coagglutination test, more than 60% of the specimens agglutinated the control reagent. These non-specific reactions were markedly reduced by preincubation of the specimens with non-immune rabbit serum and further heating at 80° C for 45 min. Such treatment did not reduce the specific activity in the coagglutination test when rotavirus-containing stools were tested. The coagglutionation test was compared with ELISA in 290 stools positive or negative for rotavirus. The sensitivity of the coagglutination test was 92%, the specificity 91% and the predictive value 31%. These results indicate that coagglutination is a suitable test for rapid screening of rotavirus infection in clinical practice.ZusammenfassungFür den Nachweis von Rotavirus in Stuhlproben Neugeborener wird ein einfacher und schneller Staphylokokken-Koagglutinationstest mit Anwendung von Kaninchen-Antiserum gegen das Nebraska-Kälberdiarrhöe-Virus (NCDV) vorgestellt. Bei direkter Prüfung im Koagglutinationstest agglutinierten mehr als 68% der Proben die Kontrollsubstanz. Diese unspezifischen Reaktionen wurden durch Vorinkubation der Proben mit dem Serum nicht immunisierter Kaninchen und 45minütiges Erhitzen auf 80° C erheblich vermindert. Bei Testung Rotavirushaltiger Stühle wurde durch diese Vorbehandlung keine Verminderung der spezifischen Aktivität im Koagglutinationstest hervorgerufen. Beim Vergleich der Ergebnisse von Koagglutinationstest und ELISA in 290 Rotavirus-positiven oder -negativen Stühlen ergab sich für den Koagglutinationstest eine Sensitivität von 92%, Spezifität von 91% und ein prädiktiver Wert von 31%. Diese Ergebnisse zeigen, daß sich der Koagglutinationstest für das Schnellscreening auf Rotavirus-Infektionen in der klinischen Praxis eignet.

3. EPIDEMIOLOGY OF PEDIATRIC HIV INFECTION IN ITALY

By April 1988, 955 (1.5%) children with AIDS had been reported to the U.S. Centers for Disease Control (CDC). Some had received blood transfusions, but 77% were born to mothers at risk of AIDS. In Italy the prevalence of HIV infection among intravenous drug users ranges from 40-80% in different urban areas, and is higher than in most European countries. Although the definition of pediatric AIDS is limited and does not cover important aspects of symptomatic HIV infection, in Italy children with full-blown AIDS represent 3% of all reported cases. In 1985 an Italian Register for pediatric HIV infection was activatd by the Italian Pediatric Society. By March 1988, 544 children “at risk” were reported. 485 (90%) were born to seropositive mothers and the remaining children acquired the infection through transfusions. The distribution of children who acquired the infection from mother follows that of drug addiction in the country; most of the children who acquired the infection through blood transfusion (often b-Thalassemic) were observed in Sardinia According to the CDC classification 165 children born to HIV positive mothers are “infected”, 92 “not infected“ and 228 “indeterminate. Over 80% of infected patients were symptomatic (28 died) and 10%, despite the absence of symptoms, have some immunological modifications. Symptoms usually appear in the first year of life. In USA 60% of children born to HIV positive mothers are in foster care or adopted, in Italy more than 80% live with their natural families.