Luisa Galli

University of Florence, Florens, Tuscany, Italy

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Publications (182)711.93 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: To provide epidemiological data on pertussis in a highly vaccinated paediatric population, focusing on the age of the infected children. We analysed data from the regional hospital discharge database on children hospitalised for pertussis in Tuscany, Italy, from January 2000 to December 2012. A total of 279 cases were recorded. The majority of hospitalised children were infants (75.6%), who had the highest rate of complications (24.2%) of any age group and a crude mortality rate of 9.47 per 1,000. The overall hospitalisation rate decreased significantly during the study period, from 4.23 to 2.82 per 100,000, but when we analysed the data by age groups we found notable differences. Hospitalisation rates in the one to four-year-old age group decreased significantly from 2.82 in the year 2000 to zero per 100,000 in 2012 and decreased significantly in the five to nine-year-old year age group over the same period, from 6.58 to 0.63 per 100,000. Overall hospitalisation rates in the infant group remained high at 53.14 per 100,000, with three peaks due to periodic pertussis outbreaks. Pertussis is still a relevant health concern in infants who are unvaccinated or incompletely immunised, both in terms of morbidity and mortality. This article is protected by copyright. All rights reserved.
    Acta Paediatrica 04/2014; · 1.97 Impact Factor
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    ABSTRACT: Highly Active Antiretroviral Therapy (HAART) changed the natural history of pediatric HIV infection. This review focuses on trends of HIV-associated cancers in childhood in the HAART era and analyses potential pathogenetic mechanisms. HAART reduced AIDS-defined malignancies (ADM), but incidence of several non-ADM is increasing. HIV-associated immune activation and inflammation, promoting tumorigenesis, can only partially be reduced by HAART. In addition, HIV-infected children may undergo accelerated immune senescence that favors cancer development. How HAART affects this condition is an open question. Lastly, there is no evidence that prenatal exposure to HAART increases the risk of cancer in childhood, but long-term studies are needed.
    Cancer letters 02/2014; · 4.86 Impact Factor
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    ABSTRACT: one of the World Health Organization Millennium Development Goal is to reduce tuberculosis incidence by 2015. However, more of 8.5 million tuberculosis cases have been reported in 2011, with an increase of multidrug-resistant strains. Therefore, the World Health Organization target cannot be reach without the help of a vaccine able to limit the spread of tuberculosis. Nowadays, bacille Calmette-Guérin is the only vaccine available against tuberculosis. It prevents against meningeal and disseminated tuberculosis in children, but its effectiveness against pulmonary form in adolescents and adults is argued. a systematic review was performed by searches of Pubmed, references of the relevant articles and Aeras and ClinicalTrial.gov websites. 100 articles were included in this review. Three viral vectored booster vaccines, five protein adjuvant booster vaccines, two priming vaccines and two therapeutic vaccines have been analyzed. Several vaccines are in the pipeline, but further studies on basic research, clinical trial and mass vaccination campaigns are needed to achieve the TB eradication target by 2050.
    BMC Infectious Diseases 01/2014; 14 Suppl 1:S2. · 3.03 Impact Factor
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    ABSTRACT: Many and large dumps exist in our knowledge about Mycobacterium tuberculosis infection and disease in infants and children. We still do not understand why some individuals do acquire and others do not acquire the infection in the presence of the same risk factors. We do not understand why some individuals convert from latent to active tuberculosis and why other individuals convert from active to inactive tuberculosis even without treatment.
    BMC Infectious Diseases 01/2014; 14 Suppl 1:S1. · 3.03 Impact Factor
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    ABSTRACT: Previous meta-analyses regarding the performance of interferon-gamma release assays (IGRAs) for tuberculosis diagnosis in children yielded contrasting results, probably due to different inclusion/exclusion criteria. We systematically searched PubMed, EMBASE and Cochrane databases and calculated pooled estimates of sensitivities and specificities of QuantiFERON-TB Gold In Tube (QFT-G-IT), T-SPOT.TB, and tuberculin skin test (TST). Several sub-analysis were performed: stratification by background (low income vs. high income countries); including only microbiological confirmed TB cases; including only studies performing a simultaneous three-way comparison of the three tests, and including immunocompromised children. Overall, 31 studies (6183 children) for QFT-G-IT, 14 studies (2518 children) for T-SPOT.TB and 34 studies (6439 children) for TST were included in the analyses. In high income countries QFT-G-IT sensitivity was 0.79 (95%IC: 0.75-0.82) considering all the studies, 0.78 (95%CI:0.70-0.84) including only studies performing a simultaneous three-way comparison and 0.86 (95%IC 0.81-0.90) considering only microbiologically confirmed studies. In the same analyses T-SPOT.TB sensitivity was 0.67 (95%IC 0.62-0.73); 0.76 (95%CI: 0.68 to 0.83); and 0.79 (95%IC 0.69-0.87), respectively. In low income countries QFT-G-IT pooled sensitivity was significantly lower: 0.57 (95%IC:0.52-0.61), considering all the studies, and 0.66 (95%IC 0.55-0.76) considering only microbiologically confirmed cases; while T-SPOT.TB sensitivity was 0.61 (95%IC 0.57-0.65) overall, but reached 0.80 (95%IC 0.73-0.86) in microbiologically confirmed cases. In microbiologically confirmed cases TST sensitivity was similar: 0.86 (95%IC 0.79-0.91) in high income countries, and 0.74 (95%IC 0.68-0.80) in low income countries. Higher IGRAs specificity with respect to TST was observed in high income countries (97-98% vs. 92%) but not in low income countries (85-93% vs. 90%). Both IGRAs showed no better performance than TST in low income countries.
    BMC Infectious Diseases 01/2014; 14 Suppl 1:S6. · 3.03 Impact Factor
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    ABSTRACT: Paediatric tuberculosis (TB) represents a major public health concern worldwide. About 1 million children aged less than 15 years develop TB each year, contributing to 3-25% of the total TB caseload. The aim of this review is to evaluate national and international guidelines concerning tuberculosis in childhood and compare them in terms of diagnosis and treatment strategies. A literature search of the Pubmed database was performed from January 2000 to August 2013, using the terms "tuberculosis" and "children". The search was limited to guidelines and consensus conferences, human species and full text availability, with no language restrictions. Twenty-seven national and international guidelines are identified. Several discrepancies on the diagnosis workup of TB are underlined. The main points of disagreement are represented by the interpretation of tuberculin skin test (TST) result and the recommendations on the use of TST and/or interferon-gamma release assay (IGRA) for the diagnosis of TB infection. Otherwise, all guidelines are in agreement that a microbiological confirmation should always be sought. Similarly, susceptibility drug testing and genotyping should be performed whenever it is possible on the basis of resources availability. On the contrary, the use of nucleic acid amplification tests (NAATs) for the M. tuberculosis detection is still controversial. A general consensus exists, otherwise, on TB treatment and only minor discrepancies are evidenced, such as the recommendations on daily or intermittent treatment regimens. Despite advances in TB diagnostic tools have been reached during the last decade, a lack of uniformity in their availability, indication and interpretation has relevant consequences for clinical practice. Further studies need to be performed to clarify this issue and identify a reliable and reproducible diagnostic workup. Moreover, future studies should analyze the drug metabolism and the efficacy of intermittent dosing regimes in childhood, as well as new treatment regimens in order to improve the therapy compliance.
    BMC Infectious Diseases 01/2014; 14 Suppl 1:S3. · 3.03 Impact Factor
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    ABSTRACT: Data on HIV/TB co-infection in children are still lacking. There are on-going large clinical trials on the prevention and treatment of TB/HIV infection in children that hopefully will help to guide an evidence-based clinical practice in both resource-rich and resource-limited settings.HIV is the top and tuberculosis is the second leading cause of death from infectious disease worldwide, with an estimated 8.7 million incident cases of tuberculosis and 2.5 million new HIV infections annually. The World Health Organization estimates that HIV prevalence among children with tuberculosis, in countries with moderate to high prevalence, ranges from 10 to 60%. The mechanisms promoting susceptibility of people with HIV to tuberculosis disease are incompletely understood, being likely caused by multifactorial processes.
    BMC Infectious Diseases 01/2014; 14 Suppl 1:S5. · 3.03 Impact Factor
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    ABSTRACT: The ongoing spread of tuberculosis (TB) in poor resource countries and the recently increasing incidence in high resource countries lead to the need of updated knowledge for clinicians, particularly for pediatricians. The purpose of this article is to provide an overview on the most important peculiarities of TB in children. Children are less contagious than adults, but the risk of progression to active disease is higher in infants and children as compared to the subsequent ages. Diagnosis of TB in children is more difficult than in adults, because few signs are associated with primary infection, interferon-gamma release assays and tuberculin skin test are less reliable in younger children, M. tuberculosis is more rarely detected in gastric aspirates than in smears in adults and radiological findings are often not specific. Treatment of latent TB is always necessary in young children, whereas it is recommended in older children, as well as in adults, only in particular conditions. Antimycobacterial drugs are generally better tolerated in children as compared to adults, but off-label use of second-line antimycobacterial drugs is increasing, because of spreading of multidrug resistant TB worldwide. Given that TB is a disease which often involves more than one member in a family, a closer collaboration is needed between pediatricians and clinicians who take care of adults.
    BMC Infectious Diseases 01/2014; 14 Suppl 1:S4. · 3.03 Impact Factor
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    ABSTRACT: Italian guidelines for the management of fever in children (IFG) have been published in 2009 and thereafter disseminated in all country. A survey was conducted before their publication and three years later to investigate their impact on knowledge and behaviors of paediatricians. A questionnaire was administered to convenient samples of paediatricians in 2009 and in 2012, eliciting information about fever definition, methods of temperature measurement, and antipyretic use. Differences in responses between 2009 and 2012 and between paediatricians who were or were not aware of the IFG were evaluated. The responses rates were 74% (480/648) in 2009 and 69% (300/434) in 2012. In 2012 168/300 (56%) of participants were aware of the IFG. The proportion of paediatricians who correctly would never suggest the use of physical methods increased from 18.7% to 36.4% (P < 0.001). In 2009 11% of paediatricians declared that the use of antipyretic drugs depends on patient discomfort and did not use a temperature cut off. In 2012 this percentage reached 45.3% (P < 0.001). Alternate use of antipyretics decreased from 27.0% to 11.3% (P < 0.001). Use of rectal administration of antipyretics in absence of vomiting decreased from 43.8% in 2009 to 25.3% in 2012 (P < 0.001). In general, improvements were more striking in paediatricians who were aware the IFG than in those who were not aware of them CONCLUSIONS: Behaviours of Italian paediatricians improved over time. However, some wrong attitudes need to be further discouraged, including use of physical methods and misuse of rectal administration. Further strategy to disseminate the IFG could be needed.
    BMC Pediatrics 12/2013; 13(1):210. · 1.98 Impact Factor
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    ABSTRACT: Increasing levels of paediatric community-acquired pneumonia (CAP), caused by drug-resistant bacteria and antimicrobial resistance, vary with age and countries and, in some cases, serotypes. When empirical first-line treatment administration fails, paediatricians should consider second-line treatments based on the prevalence of local resistance. A more judicious use of antimicrobial agents is also required. Knowledge of local epidemiology and an appropriate use of antimicrobial drugs are necessary to treat CAP in this era of antimicrobial resistance.
    Acta paediatrica (Oslo, Norway: 1992). Supplement 12/2013; 102(465):25-33.
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    ABSTRACT: To critically summarise the available data on diagnosis of CAP in children, focusing on the newest findings and on the need for new studies. Eighty studies on the diagnosis of paediatric community-acquired pneumonia were scrutinised. We found no significant associations between the signs or symptoms and aetiology of pneumonia and concluded that chest radiographs remain controversial and real-time polymerase chain reaction appears more sensitive than blood cultures. Antibiotic overuse could make it difficult to differentiate viral and bacterial causes. Molecular methods provide promising tools for diagnosing infection by atypical bacteria, but are expensive and should be used selectively.
    Acta paediatrica (Oslo, Norway: 1992). Supplement 12/2013; 102(465):17-24.
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    ABSTRACT: The goal of this study was to compare the current guidelines on diagnosis and treatment of paediatric community-acquired pneumonia (CAP) in developing and developed countries. A literature search was performed consulting the Medline, Embase, Current Contents, National Guideline Clearinghouse and Cochrane database, from January 2000 to March 2013. Twelve guidelines were selected: six from developed countries and six from developing countries. Major discrepancies between the diagnosis and treatment approaches recommended by guidelines covering developing and developed countries were revealed. The search also highlighted differences between recommendations issued in similar settings. The guidelines show wide variations and weak recommendations and further research is needed to improve clinical outcomes and make better use of resources.
    Acta paediatrica (Oslo, Norway: 1992). Supplement 12/2013; 102(465):4-16.
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    ABSTRACT: Data from 484 children (median age: 6 years; 46.5% immigrants) hospitalized for tuberculosis in 31 Tuscan hospitals in 1997-2011 were analyzed. Incidence increased from 7.3 (95% confidence interval: 4.9-9.4) to 12.5 (95% confidence interval: 9.6-15.4) per 100,000 (P = 0.009). Increases were particularly profound in children <5 years of age, reaching 13.3 (95% confidence interval: 7.8-18.9; P < 0.0001 for 2011 vs.1997) per 100,000. Pediatric tuberculosis is a major issue in Tuscany.
    The Pediatric Infectious Disease Journal 11/2013; 32(11):1289-91. · 3.57 Impact Factor
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    ABSTRACT: Pediculosis capitis is a worldwide health problem. One of the most important factor in effective head lice eradication is to ensure that infestation is adequately recognized and treated. Our survey investigated the knowledge and practice among primary care Italian pediatricians regarding to the prevention and treatment of head lice. The questionnaire was distributed to all the pediatricians registered at the Annual Congress of Practice in Pediatrics held in Florence, Italy, November 11--12, 2011. It includes 10 questions in a multiple choice format, and one answer for each question was provided. The questionnaire was conceived by pediatricians at the Infectious Disease Unit of the Department of Science for the Health of Woman and Child, University of Florence. Questions were designed according to the guidelines by the Italian Pediatric Society (SIP), and international guidelines, such as the Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics (AAP). Overall, 364/600 pediatricians (60.7% of physicians registered to the Congress) returned the questionnaire. The majority of them (232/364; 63,7%) believe that parents consult their primary care pediatrician only after the failure of other "remedies". Mostly, they prescribe Malathion (116/364, 31,8%) as first line treatment. Two-hundred-fourty-three (66.7%) of participants consider creams, foams and gels the most effective formulations. Two-hundred-sixty-two of pediatricians interviewed (72.0%) suggest to repeat the treatment after one week, 37/364 (10.2%) after two weeks. The majority of the pediatricians interviewed reported that recurrences occur in less than 30% of cases (279/364; 76,6%). In their own opinion, most of recurrences are the consequence of a reinfestation in the community (259/264; 77%). Three-hundred-thirty-four (91.7%) of them have never prescribed oral therapy for the treatment of head lice. Finally, 289/364 (79.4%) pediatricians believe that no product is effective for prevention. This is the first study that investigates the clinical practice of family pediatricians about the management and treatment of head lice globally, the Italian pediatricians surveyed proved to be quite informed on the head lice management. However, even in a country where pediatric assistance is free for everybody, a considerable proportion of parents do not seek advice to their own family pediatrician. Therefore, educations of parents, other than continuous updating of pediatricians, may contribute to a better management of head lice in the community.
    Italian Journal of Pediatrics 10/2013; 39(1):62. · 1.34 Impact Factor
  • The Pediatric Infectious Disease Journal 08/2013; 32(8):928-9. · 3.57 Impact Factor
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    ABSTRACT: Drug-resistant tuberculosis (DR-TB) is emerging as an increasing problem worldwide and no consensus has been reached about the management of children contacts of DR-TB cases. To evaluate the role of post-exposure chemoprophylaxis in paediatric DR-TB contacts, focusing on literature findings and recommendations from existing international guidelines. We conducted a literature search of the Cochrane Library, MEDLINE by PubMed and EMBASE from database inception through September 2012, using an appropriate search strategy. Eighteen articles were included: four retrospective and two prospective population studies, eight international guidelines and four narrative reviews. general agreement exists that preventive therapy could be beneficial in specific high-risk groups, including immunocompromised children and those aged <5 years. However, no consensus exists on the use of preventive therapy in older or immunocompetent children and on which regimen should be preferred.
    Journal of chemotherapy (Florence, Italy) 06/2013; · 0.83 Impact Factor
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    ABSTRACT: New available immunologic tests for tuberculosis (TB) diagnosis are Interferon-gamma release assay (IGRA). In adults these tests showed a higher specificity than tuberculin skin test (TST) but their superior sensitivity compared to TST sensitivity has not been proved yet. In children, interpretation of results remains disputed, especially in those <5 years. Hereby we report the most recent literature data for use and interpretation of IGRA is results in children.
    Minerva pediatrica 06/2013; 65(3):341-347. · 0.64 Impact Factor
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    ABSTRACT: Herpes simplex encephalitis classically involves the periventricular white matter in infants and the mesial temporal lobes, inferior frontal lobes, and insula in older children and adults. However, the increasing use of polymerase chain reaction to detect viral DNA in the cerebrospinal fluid has allowed the expansion of the spectrum of radiologic findings possibly associated with herpes simplex encephalitis. This study presents a rare case of a previously healthy infant with herpes simplex encephalitis with occipital involvement and permanent visual impairment. Possible pathogenic mechanisms are discussed.
    Pediatric Neurology 06/2013; 48(6):463-5. · 1.42 Impact Factor
  • Journal of Pediatric Gastroenterology and Nutrition 06/2013; 56(6):48-9. · 2.20 Impact Factor
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    ABSTRACT: BACKGROUND: Resurgence of pertussis in the post-vaccination era has been reported in Western countries. A shift of cases from school-age children to adolescents, adults and children under 1 year of age has been described in the last decade, and mortality rates in infants are still sustained. We aimed to review and discuss the possible vaccination strategies which can be adopted in order to improve the pertussis control, by searches of Pubmed, and websites of US and European Centers for Disease Control and Prevention, between 1st January 2002, and 1st March 2013. DISCUSSION: The following vaccination strategies have been retrieved and analysed: the cocooning strategy, the immunization of pregnant women and newborns, vaccination programs for preschool children, adolescents, adults and health-care workers. Cost-effectiveness studies provide some contrasting data, mainly supporting both maternal vaccination and cocooning. Adolescent and/or adult vaccination seems to be cost-effective, however data from observational studies suggest that this vaccination strategy, used alone, leads to a reduced pertussis burden globally, but does not affect the disease incidence in infants. Moreover, substantial logistical and economic difficulties have to be overcome to vaccinate the largest number of individuals. SUMMARY: The simultaneous use of more than one strategy, including cocooning strategy plus vaccination of adolescents and adults, seems to be the most reasonable preventive measure. The development of new highly immunogenic and efficacious pertussis vaccines continues to be a primary objective for the control of pertussis.
    BMC Infectious Diseases 03/2013; 13(1):151. · 3.03 Impact Factor

Publication Stats

1k Citations
214 Downloads
711.93 Total Impact Points

Institutions

  • 1989–2014
    • University of Florence
      • • Dipartimento di Medicina Sperimentale e Clinica
      • • Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino
      Florens, Tuscany, Italy
  • 1996–2012
    • Ospedale Pediatrico Meyer Firenze
      Florens, Tuscany, Italy
  • 2007
    • Università di Pisa
      Pisa, Tuscany, Italy
  • 1997–2001
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      • Institute for Advanced Biomedical Technologies ITAB
      Chieti, Abruzzo, Italy
  • 1991–2000
    • Università degli Studi di Torino
      Torino, Piedmont, Italy