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ABSTRACT: We present the case of two Australian tourists aged 25 and 26 years who, after immersion in a canal in Venice, developed severe leptospirosis. After a 1-week history of fever, headache, myalgia, and vomiting they developed jaundice and renal failure. Complete remission was achieved by antibiotic therapy and hemodialysis.
Journal of Travel Medicine 03/2013; 20(2):128-30. · 1.75 Impact Factor
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Alessandro Bartoloni,
Lucia Pallecchi,
Connie Fernandez,
Antonia Mantella,
Eleonora Riccobono,
Donata Magnelli,
Dario Mannini,
Marianne Strohmeyer,
Filippo Bartalesi,
Higinio Segundo,
Joaquin Monasterio,
Hugo Rodriguez,
César Cabezas,
Eduardo Gotuzzo,
Gian Maria Rossolini
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ABSTRACT: OBJECTIVE: To investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in rural and urban community settings of Bolivia and Peru. METHODS: MRSA nasal carriage was investigated in 585 individuals living in rural and urban areas of Bolivia and Peru (one urban area, one small rural village, and two native communities, one of which was highly isolated). MRSA isolates were subjected to molecular analysis for the detection of virulence genes, characterization of the staphylococcal cassette chromosome mec (SCCmec), and genotyping (multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE)). RESULTS: An overall very low prevalence of MRSA nasal carriage was observed (0.5%), with MRSA carriers being detected only in a small rural village of the Bolivian Chaco. The three MRSA isolates showed the characteristics of community-associated MRSA (being susceptible to all non-beta-lactam antibiotics and harboring the SCCmec type IV), were clonally related, and belonged to ST1649. CONCLUSIONS: This study provides an insight into the epidemiology of MRSA in community settings of Bolivia and Peru. Reliable, time-saving, and low-cost methods should be implemented to encourage continued surveillance of MRSA dissemination in resource-limited countries.
International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 12/2012; · 2.17 Impact Factor
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ABSTRACT: We present a case of a 60-year-old Caucasian woman carrying a 2-year-old hip prosthesis infected by Candida glabrata dose-dependent susceptible to fluconazole and voriconazole. Resection arthroplasty was performed. Six weeks of caspofungin plus liposomal amphotericin combination therapy achieved joint sterilization and allowed a successfully reimplantation arthroplasty. In addition we review 9 cases of C. glabrata prosthetic joint infection described to date in the literature.
American journal of orthopedics (Belle Mead, N.J.) 11/2012; 41(11):500-5.
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ABSTRACT: We describe a patient with severe psoriasis and hepatitis C simultaneously treated with pegylated interferon alpha (peg-IFNα) plus ribavirin and etanercept, whose skin lesions improved and who reached a sustained virological response. This case suggests that refractory psoriasis can today no longer be considered as a contraindication for combined hepatitis C virus treatment.
Scandinavian Journal of Infectious Diseases 10/2012; · 1.72 Impact Factor
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Filippo Bartalesi,
Delia Goletti,
Michele Spinicci,
Annalisa Cavallo,
Letizia Attala,
Jessica Mencarini,
Ginevra Fiori,
Francesca Li Gobbi,
Antonia Mantella,
Maurizio Benucci,
Francesca Prignano,
Nicola Pimpinelli,
Marco Matucci Cerinic,
Enrico Girardi, Alessandro Bartoloni
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ABSTRACT: OBJECTIVES: To evaluate the T-cell interferon (IFN)-γ response to Mycobacterium tuberculosis-specific antigens during latent tuberculosis infection (LTBI) therapy in candidates for tumor necrosis factor-α inhibitors (TNFi). METHODS: 1,490 patients were screened for LTBI. One-hundred and sixty-six of them were treated for LTBI and followed-up with QuantiFERON-TB Gold (QFT-IT) testing at baseline (T0) and therapy completion (T1); 92 subjects were also tested 3-6 months after therapy completion (T2). RESULTS: At T1 the QFT-IT reversion and conversion rates were 24% (27/111) and 18% (10/55), respectively. By multivariate analysis, the likelihood of reversion significantly decreased with older age (>50-60), larger TST size (>15mm) and higher IFN-γ value at T0 (>1IU/ml); the likelihood of conversion increased with higher IFN-γ levels at T0 (1IU/ml) and in female patients. Quantitative data among those who scored QFT-IT-positive at T0 showed a decreasing trend of IFN-γ levels between T0 and T1 that reached statistical significance when T0 was compared to T2, and T1 to T2. CONCLUSIONS: The data confirm the difficulty of interpreting the modulation of IFN-γ levels during LTBI therapy. Currently, there is no evidence to support the use of QFT-IT in the clinical practice of monitoring LTBI treatment in candidates for TNFi.
The Journal of infection 10/2012; · 4.13 Impact Factor
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Elisa Bruno, Alessandro Bartoloni,
Vito Sofia,
Florentina Rafael,
Donata Magnelli,
Sandra Padilla,
Graziella Quattrocchi,
Filippo Bartalesi,
Higinio Segundo,
Mario Zappia,
Pierre-Marie Preux,
Alessandra Nicoletti
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ABSTRACT: Epilepsy is associated with a significant burden of social stigma that appears to be influenced by psychosocial and cultural factors. Stigma has a negative effect on the management of people with epilepsy (PWE), representing one of the major factors that contribute to the burden of epilepsy. To assess stigma perception among the Guarani population, one hundred thirty-two people living in Guaraní communities in Bolivia were invited to complete the Stigma Scale of Epilepsy questionnaire. The main determinants of stigma identified were: the fear linked to loss of control, the feelings of sadness and pity toward PWE, the difficulties faced by PWE in the professional and relationship fields, the level of education and type of seizure. Our study pointed out that, in this population, PWE face difficulties in everyday life because of epilepsy-associated stigma and the results attest to the importance of promoting community-based educational programs aimed at reducing the stigmatization process.
Epilepsy & Behavior 08/2012; 25(1):131-6. · 2.34 Impact Factor
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Lucia Pallecchi, Alessandro Bartoloni,
Eleonora Riccobono,
Connie Fernandez,
Antonia Mantella,
Donata Magnelli,
Dario Mannini,
Marianne Strohmeyer,
Filippo Bartalesi,
Hugo Rodriguez,
Eduardo Gotuzzo,
Gian Maria Rossolini
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ABSTRACT: Quinolones are potent broad-spectrum bactericidal agents increasingly employed also in resource-limited countries. Resistance to quinolones is an increasing problem, known to be strongly associated with quinolone exposure. We report on the emergence of quinolone resistance in a very remote community in the Amazon forest, where quinolones have never been used and quinolone resistance was absent in 2002.
The community exhibited a considerable level of geographical isolation, limited contact with the exterior and minimal antibiotic use (not including quinolones). In December 2009, fecal carriage of antibiotic resistant Escherichia coli was investigated in 120 of the 140 inhabitants, and in 48 animals reared in the community. All fluoroquinolone-resistant isolates were genotyped and characterized for the mechanisms of plasmid- and chromosomal-mediated quinolone resistance.
Despite the characteristics of the community remained substantially unchanged during the period 2002-2009, carriage of quinolone-resistant E. coli was found to be common in 2009 both in humans (45% nalidixic acid, 14% ciprofloxacin) and animals (54% nalidixic acid, 23% ciprofloxacin). Ciprofloxacin-resistant isolates of human and animal origin showed multidrug resistance phenotypes, a high level of genetic heterogeneity, and a combination of GyrA (Ser83Leu and Asp87Asn) and ParC (Ser80Ile) substitutions commonly observed in fluoroquinolone-resistant clinical isolates of E. coli.
Remoteness and absence of antibiotic selective pressure did not protect the community from the remarkable emergence of quinolone resistance in E. coli. Introduction of the resistant strains from antibiotic-exposed settings is the most likely source, while persistence and dissemination in the absence of quinolone exposure is likely mostly related with poor sanitation. Interventions aimed at reducing the spreading of resistant isolates (by improving sanitation and water/food safety) are urgently needed to preserve the efficacy of quinolones in resource-limited countries, as control strategies based only on antibiotic restriction policies are unlikely to succeed in those settings.
PLoS Neglected Tropical Diseases 08/2012; 6(8):e1790. · 4.69 Impact Factor
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Emerging Infectious Diseases 02/2012; 18(2):339-40. · 6.79 Impact Factor
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ABSTRACT: The first symptoms of malaria, common to all the different malaria species, are nonspecific and mimic a flu-like syndrome. Although fever represents the cardinal feature, clinical findings in malaria are extremely diverse and may range in severity from mild headache to serious complications leading to death, particularly in falciparum malaria. As the progression to these complications can be rapid, any malaria patient must be assessed and treated rapidly, and frequent observations are needed to look for early signs of systemic complications.In fact, severe malaria is a life threatening but treatable disease. The protean and nonspecific clinical findings occurring in malaria (fever, malaise, headache, myalgias, jaundice and sometimes gastrointestinal symptoms of nausea, vomiting and diarrhoea) may lead physicians who see malaria infrequently to a wrong diagnosis, such as influenza (particularly during the seasonal epidemic flu), dengue, gastroenteritis, typhoid fever, viral hepatitis, encephalitis. Physicians should be aware that malaria is not a clinical diagnosis but must be diagnosed, or excluded, by performing microscopic examination of blood films. Prompt diagnosis and appropriate treatment are then crucial to prevent morbidity and fatal outcomes. Although Plasmodium falciparum malaria is the major cause of severe malaria and death, increasing evidence has recently emerged that Plasmodium vivax and Plasmodium knowlesi can also be severe and even fatal.
Mediterranean Journal of Hematology and Infectious Diseases 01/2012; 4(1):e2012026.
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ABSTRACT: INTRODUCTION: Certain fluoroquinolones share similar indications of use. A comparison among Cardiovascular and metabolic (i.e., dysglycemia) safety profiles of the fluoroquinolones might be particularly useful for the prescribers' decision-making process as well as to hypothesize future researcher purposes. AREAS COVERED: A literature search was conducted using keywords apt to identify information on safety profile of the fluoroquinolones. Publications concerned with descriptive and etiological surveys were manually reviewed. EXPERT OPINION: Cardiac alterations and blood glucose impairments might be associated with any fluoroquinolone. However, the benefit/risk profile of these agents could be stratified for the single compounds. Several predisposing factors, such as diabetes, heart illnesses and their related pharmacotherapies, might exacerbate the risk of potentially serious adverse events. In this context, the opportunity of the more appropriate choice among different fluoroquinolones could be applicable.
Expert Opinion on Drug Safety 09/2011; 11(1):53-69. · 3.02 Impact Factor
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Elisa Bruno, Alessandro Bartoloni,
Vito Sofia,
Florentina Rafael,
Donata Magnelli,
Elio Ortiz,
Sandra Padilla,
Graziella Quattrocchi,
Filippo Bartalesi,
Higinio Segundo,
Mario Zappia,
Pierre-Marie Preux,
Alessandra Nicoletti
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ABSTRACT: This study was performed to analyze sociocultural beliefs about epilepsy among Guaraní communities in Bolivia. People with epilepsy, their family members, the general population, and local health care personnel were interviewed about the meaning of and beliefs, feelings, and practices concerning epilepsy. Epilepsy is called mano-mano, a term that means being in a constant passage between life and death. The disease is attributed mainly to a failure to observe a fasting period and to other eating habits. Natural remedies are the most recommended treatments even though half of respondents reported that antiepileptic drugs may be effective. The concept of epilepsy as an embodied disease with natural causes appears to differ from that documented in other traditional societies. People with epilepsy do not represent a threat to the community, which seems to have an attitude aimed at their protection. Moreover, people from these communities appear to favor a combination of biomedical and traditional care systems.
Epilepsy & Behavior 08/2011; 22(2):346-51. · 2.34 Impact Factor
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Maria Chiara Dell'Amico,
Annalisa Cavallo,
José Luis Gonzales,
Sara Irene Bonelli,
Ybar Valda,
Angela Pieri,
Higinio Segund,
Ramón Ibañez,
Antonia Mantella,
Filippo Bartalesi,
Francesco Tolari, Alessandro Bartoloni
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ABSTRACT: We determined the seroprevalence of hepatitis E virus (HEV) in persons in 2 rural communities in southeastern Bolivia and the presence of HEV in human and swine fecal samples. HEV seroprevalence was 6.3%, and HEV genotype 3 strains with high sequence homology were detected.
Emerging Infectious Diseases 08/2011; 17(8):1488-90. · 6.79 Impact Factor
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ABSTRACT: We have previously observed high rates of acquired antibiotic resistance in commensal Escherichia coli from healthy children living in urban areas of Bolivia and Peru, including resistance to tetracycline and quinolones, which are not routinely used in childhood. In this work we investigated acquired resistance in commensal E. coli from healthy children and home-raised chickens in 12 households from one of the previously surveyed urban area in Bolivia, to ascertain the possibility of human-animal exchange of resistant strains in similar settings. The resistance rates to ampicillin, tetracycline, chloramphenicol, streptomycin, and trimethoprim-sulphametoxazole were overall high (≥50%) and comparable between children and chickens, whereas those to quinolones were significantly higher in chickens (81% vs. 29% for nalidixic acid; 43% vs. 10% for ciprofloxacin). Molecular characterization of tetracycline- and quinolone-resistant isolates (n = 66) from children and chickens of three selected households revealed a remarkable clonal diversity and, in some cases, the presence of the same resistant strains among children or among chickens living in the same household, but not between children and chickens. Several resistance plasmids were characterized, but inter-clonal plasmid dissemination was not detected. Overall, the results from the present study suggested that cross-transmission between children and home-raised chickens could not represent a major spreading mechanism for resistant E. coli in households of resource-limited settings with high human-animal promiscuity.
Microbial drug resistance (Larchmont, N.Y.) 06/2011; 18(1):83-7. · 1.99 Impact Factor
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Clinical Infectious Diseases 03/2011; 52(5):690-1. · 9.15 Impact Factor
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Stefania Taffon,
Gabriella Bidini,
Francesca Vichi,
Giampaolo Corti,
Domenico Genovese,
Loreta A Kondili,
Rita Bindi,
Fulvio Armellini,
Francesco Leoncini, Alessandro Bartoloni,
Francesco Mazzotta,
Maria Rapicetta
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ABSTRACT: Acute Hepatitis A Virus (HAV) is reported to be an emergent problem in several developed countries.
The aim of this study was to analyse the HAV strains circulating among individuals with acute HAV infection, apparently transmitted by different routes, in several districts of Tuscany in central Italy, during the year 2008.
An outbreak of acute HAV infection occurred from May to August 2008 in Arezzo; 32 individuals were admitted to the hospital, in 25 of them at least a linkage with an infected food handler and/or household contacts was reported and in 3 homosexuality was a possible risk factor. In Florence, from January 2008 to August 2008, 41 individuals mainly homosexual men were admitted to two hospitals with the diagnosis of acute HAV. The phylogenetic analysis of VP1/2A region of HAV was used to characterize these HAV isolates. All viral sequences were assigned to genotype IA. All clustered in the same branch (bootstrap 82%) of phylogenetic tree, thus indicating the same circulating isolate. Apart of one isolate from France and one from Germany which were similar with the "Tuscany" strain reported here, high heterogeneity with the other European HAV strains reported in the GenBank in the last years, was observed.
The detection of a unique HAV isolate circulating in different Tuscany districts, suggests sequential transmission of HAV infection in this geographical area through possible links among acute hepatitis cases. The application of safe food handling practices and vaccination of homosexual men may contribute to the prevention of HAV infection.
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 02/2011; 50(2):142-7. · 3.12 Impact Factor
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Journal of Antimicrobial Chemotherapy 02/2011; 66(5):1176-8. · 5.07 Impact Factor
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ABSTRACT: Severe imported malaria is an important problem in European countries, where approximately 8,000 cases of Plasmodium falciparum malaria are reported each year. Although the World Health Organization recommends intravenous artesunate (IVA) as the treatment of choice for severe malaria in areas of low transmission, it is rarely used in Europe, because it is not yet available as a drug manufactured under Good Manufacturing Practices. We report a series of eight imported severe falciparum malaria cases treated with IVA combined with intravenous quinine (IVQ). This combined therapy was found to be efficacious, safe, and well-tolerated. The only observed death occurred in a young man who presented 10 days after the onset of symptoms. IVA plus IVQ treatment seems to be an acceptable approach, because the legal risks in using an unlicensed drug for treating a severe malaria case denies the patient the possibility of being treated with the most effective regimen.
The American journal of tropical medicine and hygiene 08/2010; 83(2):274-6. · 2.59 Impact Factor
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Journal of Hospital Medicine 03/2010; 5(3):189-92. · 1.40 Impact Factor
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ABSTRACT: Microorganisms of the genus Methylobacterium are facultative methylotrophic, gram-negative rods that are ubiquitous in nature and rarely cause human disease, mostly in subjects with preexisting causes of immune depression. Methylobacterium fujisawaense, first proposed as a new species in 1988, has never been reported as a bacterial agent of human infections so far. Here we describe a case of M. fujisawaense infection in a relapsed acute leukaemia undergoing unrelated allogeneic hematopoietic stem cell transplantation. Molecular identification of an M. fujisawaense strain was obtained from multiple mycobacterial blood cultures.
Case Reports in Medicine 01/2010; 2010:313514.
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ABSTRACT: Considering that antibiotics play a crucial role in reducing morbidity and mortality due to bacterial infections, antibiotic
resistance is a major problem in resource-limited countries (RLCs) where there is a high burden of infectious diseases, resistance
rates are even higher than in industrialized countries, and therapeutical options are often unavailable or too expensive.
Multidrug-resistant organisms – e.g. Streptococcus pneumoniae, Salmonella Typhi, Shigella spp., Neisseria gonorrhoeae, Mycobacterium tuberculosis – have been increasingly documented. Many factors contributing to antibiotic resistance in RLCs are strongly related to poverty:
lack of knowledge or information of health-care professionals, lack of laboratory facilities, inadequate access to health
system, lack of money available to pay for the appropriate amount of antibiotics, dispensation of drugs by untrained people,
availability of substandard and counterfeit drugs, etc. Moreover, in RLCs, transmission of resistant bacteria is facilitated
by person-to-person contact, through contaminated food, unsafe water or by vectors. An understanding of this complex and multifactorial
scenario is crucial to develop any containment strategy based on the promotion of a correct use of antibiotics and infection
control measures.
12/2009: pages 199-231;
