V. Tullio

Intestinal microflora in breastfed colicky and non-colicky infants

Background: Infantile colics are a common problem in the first months of life. During this period, a process of intestinal colonization rapidly occurs. A difference in the gut microflora could play an important role in the pathogenesis of colics, changing the metabolism of carbohydrates and fatty acids. Actually, in the literature, only few data have been collected about this topic. In this study, we evaluated intestinal microflora in breastfed colicky and non‐colicky infants. Methods: Seventy‐one breastfed infants, aged 3.2 ± 0.6 wk, free from episodes of gastroenteritis and without previous assumption of antibiotic and probiotic drugs, were enrolled in the study. They were divided into two groups: colicky (42 cases) and non‐colicky (29 cases), according to Wessels criteria. Stool samples were collected, diluted and cultured on several selective media to detect lactobacilli, clostridia, Gram‐negative anaerobes and Enterobacteriaceae. Statistical analysis was performed using Students t‐test, χ2 test and a non‐parametric test (Mann‐Whitney U‐test). Results: Differences in gut microflora were found among colicky and non‐colicky infants: colicky infants were less frequently colonized by Lactobacillus spp., and more frequently by anaerobic Gram‐negative bacteria.

Antifungal activity of essential oils against filamentous fungi determined by broth microdilution and vapour contact methods

Aims:  The in vitro activity of some essential oils (EO) (thyme red, fennel, clove, pine, sage, lemon balm and lavender) against clinical and environmental fungal strains was determined.

Bacterial counts of intestinal Lactobacillus species in infants with colic.

Intestinal colonization by lactobacilli is suggested to be a prerequisite to normal mucosal immune functions. An inadequate level of lactobacilli may be involved in appearance of allergic disease of which, infantile colic, is often considered an early clinical manifestation. The aim of the study is to evaluate intestinal lactobacilli in breast‐fed infants with infantile colic and healthy infants. Fifty‐six breast‐fed infants, aged 15–60 days were enrolled in the study and divided into two groups: colicky (30 cases) and healthy (26 cases) according to Wessels criteria. Stool samples were collected, diluted and cultured on selective media. The colonies were counted, reported as colony forming unit (cfu) per gram of faeces and identified by biochemical methods. Different colonization patterns of lactobacilli were found among colicky and healthy infants. Lactobacillus brevis (4.34 × 108 cfu/g) and L. lactis lactis (2.51 × 107 cfu/g) were found only in colicky infants while L. acidophilus (2.41 × 107 cfu/g) was found only in healthy infants. Lactobacillus brevis and L. lactis lactis might be involved in the pathogenesis of infantile colic increasing meteorism and abdominal distension. Further studies are required to understand how the observed differences may be involved in the pathogenesis of this common disorder.

Faecal microbiota in breast-fed infants after antibiotic therapy.

Aim:  To evaluate modifications of gut microbiota after antibiotic therapy in breast‐fed infants.

Cell Wall Inhibitors and Bacterial Susceptibility to Phagocytosis

Clinical experience has shown that the efficacy of antibiotic therapy depends not only on the direct effect exerted by the antibiotic on a given microorganism (expressed in terms of the minimum inhibitory or minimum bactericidal concentration) but also on the functional activity of the immune system of the host. The literature reports evidence suggesting that many antimicrobial drugs can modulate host defenses in various ways. It thus follows that a possible influence (both negative and positive) of antibiotics on phagocyte functions should always be tested, especially when antibiotics are given for the treatment or prophylaxis of infections in immunocompromised patients. In these cases it would be logical to employ drugs enhancing rather than depressing host defenses.

Combined Action of Fluconazole and PMNs from Uremic Patients in Clearing Intracellular Candida albicans

Phagocyte-dependent host defenses are frequently impaired in patients with chronic renal failure, who show an increased susceptibility to infections. In these individuals, the course of bacterial and fungal infections can be more aggressive than in normal hosts, and the antimicrobial agents of choice should have a high antimicrobial effect without impairing host defenses 1,2. In such immunocompromised patients, where Candida albicans is the predominant life-threatening fungal pathogen, synergism between phagocytic cells and antifungal drugs may be crucial for successful therapy. Because we demonstrated previously that fluconazole improved the functions of normal host phagocytic cells towards C. albicans3, we investigated its influence on the activities of polymorphonuclear cells (PMNs) from chronic hemodialysis patients and renal transplant recipients against a fluconazole-susceptible clinical strain of C. albicans (minimum inhibitory concentration, MIC=0.5 μg/ml with an inoculum of 103 cfu/ml; NCCLS methodology 4). All patients participating in this study gave their informed consent. Blood samples were obtained from 60 healthy volunteers, as controls, and from 91 immunocompromised patients without any evidence of active infection, fol lowed at the Nephrology and Dialysis Unit of the Ivrea Hospital (Turin, Italy). Immunocompromised patients were divided into two groups: the first included 47 Journal of Chemotherapy Vol. 15 n. 3 (301-303) 2003

A Case of Fluconazole, Voriconazole-Resistant Cryptococcus neoformans Isolated from an Immunocompetent Patient

A healthy 22-year-old male, following an automobile accident, was admitted to CTO/CRF Hospital (Turin, Italy) and his right leg was subamputated. The patients temperature was 39.6°C. Therapy with ticarcillin and clavulanic acid (3.2 g/day/4 days) was started. Laboratory data revealed a white blood cell (WBC)count of 21,l00/mm3with 86.4% neutrophils and 7.5% lymphocytes. Hemoglobin was 10.4 g/dL and creatinine 0.83 mg/dL. HN serotypes 1 and 2 were negative, while Hepatitis B core Antibody (HBcAb)-IgGwas positive. Following two ischemic crises at the right foot, vancomycin (500 mg/day/2days) was administered. Inflammation and increasing temperature were detected. A second amputation was performed at the proximal third leg. After 2 days, an infection occurred on the postsurgical wound and a Staphylococcus capitis spp. ureolyticus strain was detected. Therapy with meropenem (2 g/day/3days) and vancomycin (lg/day/2days) was initiated. The patient became afebrile and his clinical condition improved. Therapy with meropenem was continued. After 3 weeks, the patient developed fever (38.8°C) again. Three blood cultures, using automated systems (BACTEC, Becton Dickinson Diagnostic Instrument Systems, Madrid, Spain), were performed on Sabouraud dextrose agar and yielded a yeast strain identified on CHROMagar Candida as non-Candida albicans. Antifungal susceptibility was determined by Etest (Biolife, Milan, Italy) on RPMI-1640 agar supplemented with 2% glucose. The isolate was amphotericin B susceptible but fluconazole and voriconazole resistant, with the following minimum inhibitory concentrations (MICs): fluconazole >256 mg/L; voriconazole >32 mg/L and amphotericin B=0.75 mg/L. CLSI interpretive criteria recommended for Candida spp. were used1. Before biochemical strain identification, empirical antifungal therapy with intravenous caspofungin was administered by hospital clinicians. Meanwhile the yeast strain was sent to the Mycology Laboratory, Public Health and Microbiology Department, University of Turin for final identification where it was identified by its typical microscopic morphology showing

Invasive fungal infections: observational study in two hospitals in Italy (Turin) and France (Paris)

Background Invasive fungal infections (IFIs) constitute a frequent and important complication in modern medicine and represent a relevant problem in the matter of the management of hospitalised and immunocompromised patients. The most common fungal infections, candidiasis and aspergillosis, are an important cause of morbidity and mortality in critically ill and immunocompromised patients: therefore, in spite of pharmacological development, they are still difficult to treat and to eradicate. Purpose Because the pharmacist, as a member of the multidisciplinary team, can contribute by checking the treatment prescribed, to reduce medication related problems, we conducted an observational study of IFIs in two hospitals, one in Italy (Turin) and the other in France (Paris), to give a picture of the differences in their distribution and therapeutic approach in two hospital realities. Material and methods The study was conducted using a clinical database of patients between 2012 and 2013; patients were stratified according to infection, sex, age, wards and therapy. Results Candida or aspergillus related IFIs were detected in 213 men and 107 women. Candidiasis was higher in the critical care unit (Turin 40% vs Paris 48%), prevalent in men Turin 78%; Paris 65%) and older patients (61–90 years old), with a prevalence of 67% in Turin and 49% in Paris. In France, aspergillosis was highly distributed in the critical care unit (42%) and in the haematology ward (38%), was prevalent in men (68%) and, unlike candidiasis, in younger patients (47%; 31–60 years old). A comparable study was not possible for Turin where only one systemic aspergillosis was diagnosed. The most widely used drug in both hospitals was caspofungin, followed by fluconazole in Turin and voriconazole in Paris. Conclusion A similar trend in candidiasis related IFIs, with no significant differences between the two hospitals, was detected. Conversely, there were differences in the use of drugs. To reduce the incidence and mortality rate of IFI, the therapeutic approach should take account of the epidemiological picture but the hospital pharmacist’s role is also important. In fact, the hospital pharmacist together with the hospital infections committee, can monitor and analyse consumption, perform epidemiological statistics and choose the best therapy for patients in terms of cost and efficacy. No conflict of interest.

Beyond lysozyme:antimicrobial peptides against malaria

Antimicrobial peptides (AMPs) are short amino acidic sequences with less than 100 residues. They are the components of the innate immune system not only in humans but also in plants, insects, and primitive multicellular organisms. Their role is to counteract the microorganisms, which could be potentially pathogenic for the host. AMPs active against viruses, bacteria, fungi, and parasites have been described. Among the antiparasitic AMPs reported so far, some peptides affect Plasmodium development in different phases of the biological cycle, from asexual blood stages to sexual stages in the mosquito, where AMPs can block ookinetes viability or oocyst formation. AMPs with antimalarial activity derive from different organisms, especially insects, as well as amphibians. In malaria research, AMPs have been mainly proposed for the engineering of mosquitoes or parasites to reduce or interrupt the malaria parasite transmission. In this chapter, the different classes of antimalarial AMPs (defensins, cecropins, dermaseptins) or single peptides (scorpine, melittin, gambicin) are described.