A Matteelli

San Raffaele Scientific Institute, Milano, Lombardy, Italy

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Publications (149)499.38 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) substantially challenges TB control, especially in the European Region of the World Health Organization, where the highest prevalence of MDR/XDR cases is reported. The current management of patients with MDR/XDR-TB is extremely complex for medical, social and public health systems. The treatment with currently available anti-TB therapies to achieve relapse-free cure is long and undermined by a high frequency of adverse drug events, suboptimal treatment adherence, high costs and low treatment success rates. Availability of optimal management for patients with MDR/XDR-TB is limited even in the European Region. In the absence of a preventive vaccine, more effective diagnostic tools and novel therapeutic interventions the control of MDR/XDR-TB will be extremely difficult. Despite recent scientific advances in MDR/XDR-TB care, decisions for the management of patients with MDR/XDR-TB and their contacts often rely on expert opinions, rather than on clinical evidence.This document summarises the current knowledge on the prevention, diagnosis and treatment of adults and children with MDR/XDR-TB and their contacts, and provides expert consensus recommendations on questions where scientific evidence is still lacking.
    European Respiratory Journal 03/2014; · 6.36 Impact Factor
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    Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology 01/2014; · 0.43 Impact Factor
  • Alberto Matteelli, Alberto Roggi, Anna Cc Carvalho
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    ABSTRACT: The advent of antibiotics for the treatment of tuberculosis (TB) represented a major breakthrough in the fight against the disease. However, since its first use, antibiotic therapy has been associated with the emergence of resistance to drugs. The incorrect use of anti-TB drugs, either due to prescription errors, low patient compliance, or poor quality of drugs, led to the widespread emergence of Mycobacterium tuberculosis strains with an expanding spectrum of resistance. The spread of multidrug-resistant (MDR) strains (ie, strains resistant to both isoniazid and rifampicin) has represented a major threat to TB control since the 1990s. In 2006, the first cases of MDR strains with further resistance to fluoroquinolone and injectable drugs were described and named extensively drug-resistant TB (XDR-TB). The emergence of XDR-TB strains is a result of mismanagement of MDR cases, and treatment relies on drugs that are less potent and more toxic than those used to treat drug-susceptible or MDR strains. Furthermore, treatment success is lower and mortality higher than achieved in MDR-TB cases, and the number of drugs necessary in the intensive phase of treatment may be higher than the four drugs recommended for MDR-TB. Linezolid may represent a valuable drug to treat cases of XDR-TB. Delamanid, bedaquiline, and PA-824 are new anti-TB agents in the development pipeline that have the potential to enhance the cure rate of XDR-TB. The best measures to prevent new cases of XDR-TB are the correct management of MDR-TB patients, early detection, and proper treatment of existing patients with XDR-TB.
    Clinical Epidemiology 01/2014; 6:111-118.
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    ABSTRACT: As a consequence of the rapid evolution of malaria prophylaxis recommendations throughout the world, the Italian Society of Tropical Medicine (SIMET-Società Italiana di Medicina Tropicale) has set up a working group in charge of preparing a new national guideline. Other scientific societies interested in the topic were also involved in the project. The group stated that awareness about malaria risk and characteristics, as well as protection from mosquito bites, are recommended for all travellers visiting malaria-endemic countries. The risk and benefit of malaria chemoprophylaxis must be carefully balanced before prescribing drugs: the disease-related risk must outweigh the possibility of drugs' side effects. As a general rule, malaria pills are the first choice for travellers to high-risk areas, such as sub-Saharan Africa, Eastern India, Myanmar, Eastern Indonesia, Papua New Guinea and, with some limitations, South-East Asia, and the Amazon part of Venezuela, Guyana and French Guyana. However, several other factors, such as itinerary, season, duration of trip, availability of insect bite protection, pre-existing conditions and compliance, must be taken into account. In low-risk areas, stand-by emergency treatment is the first option. In minimal-risk areas and in Plasmodium vivax areas, a prompt diagnosis only is advised (Central America, South America outside the Amazon basin, Middle East, China, Thailand, Nepal). Recommendations may be modified when particular groups of travellers are concerned, such as long-term residents, visiting friends and relatives, patients with pre-existing conditions, pregnant women and children.
    Infection 12/2013; · 2.44 Impact Factor
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    Alberto Matteelli, Silvia Odolini
    Travel Medicine and Infectious Disease 12/2013; · 1.78 Impact Factor
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    The Lancet Infectious Diseases 08/2013; 13(8):651-2. · 19.97 Impact Factor
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    ABSTRACT: BACKGROUND: Interferon-gamma release assays (IGRAs) have high specificity and sensitivity for the diagnosis of tuberculosis (TB) infection. However, their role as a screening tool in children with immunodeficiency disorders is still unclear. In the present study, we performed a contact investigation using serial IGRAs on children with immunodeficiency conditions exposed to a contagious TB patient. METHODS: Children who were exposed to a contagious TB case underwent serial QuantiFERON(®) TB Gold In-Tube (QFT-GIT) and T-SPOT(®).TB (T-SPOT) testing. RESULTS: Eighteen children were tested. At the first testing, only two children (11 %) were positive to T-SPOT. Indeterminate results were more frequent with QFT-GIT (35 %) than with T-SPOT (12 %). In the multivariable analysis, a statistically significant association of lymphocyte count <500 cells/mm(3) (p < 0.00005) and low age (p = 0.03) with indeterminate results for the QFT-GIT test but not for T-SPOT (p = 0.10 and p = 0.88, respectively) was found. At the end of October 2012, 15 of the 18 children were alive and none developed active TB disease. CONCLUSION: T-SPOT provided more determinate results and was less influenced by low age and lymphocytopenia than QFT-GIT in this population of immunodeficient children. These findings suggest that T-SPOT is a more accurate test for the identification of TB infection in young children with lymphocytopenia and should be preferred to QFT-GIT under such specific conditions.
    Infection 04/2013; · 2.44 Impact Factor
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    ABSTRACT: PURPOSE OF REVIEW: This review discusses the recent evidence on epidemiology, diagnosis, and treatment of drug-resistant and multidrug-resistant (MDR) tuberculosis (TB), an area where solutions for better diagnosis and treatment continually develop. RECENT FINDINGS: The prevalence of drug resistance has been constantly rising during the recent years. It has peaked in eastern European countries such as Belarus, where a record of 35.5% MDR-TB amongst new cases have been reported from Minsk. New diagnostic tools are becoming available. Xpert MTB/RIF is by far the most promising of these new techniques. Clinical management of drug-resistant TB is still cumbersome. However, after over 40 years of neglect, new drugs are becoming readily available: delamanid, bedaquiline, and PA-824 combined into innovative regimens raise hopes for substantially higher success rates. SUMMARY: The innovative diagnostic tools recently validated are changing the traditional paradigms of TB diagnosis, for too long based on sputum smear, culture, and drug susceptibility testing. New anti-TB compounds, which can be combined with several 'old' drugs with new indications, are gradually modifying the chances of cure for MDR-TB cases. Although initial evidence appears promising, the market use of new drugs must be accompanied by a serious public health approach aimed at preventing the development of further drug resistance.
    Current opinion in pulmonary medicine 02/2013; · 3.12 Impact Factor
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    ABSTRACT: Several studies showed that assessing levels of specific circulating microRNAs (miRNAs) is a non-invasive, rapid, and accurate method for diagnosing diseases or detecting alterations in physiological conditions. We aimed to identify a serum miRNA signature to be used for the diagnosis of tuberculosis (TB). To account for variations due to the genetic makeup, we enrolled adults from two study settings in Europe and Africa. The following categories of subjects were considered: healthy (H), active pulmonary TB (PTB), active pulmonary TB, HIV co-infected (PTB/HIV), latent TB infection (LTBI), other pulmonary infections (OPI), and active extra-pulmonary TB (EPTB). Sera from 10 subjects of the same category were pooled and, after total RNA extraction, screened for miRNA levels by TaqMan low-density arrays. After identification of "relevant miRNAs", we refined the serum miRNA signature discriminating between H and PTB on individual subjects. Signatures were analyzed for their diagnostic performances using a multivariate logistic model and a Relevance Vector Machine (RVM) model. A leave-one-out-cross-validation (LOOCV) approach was adopted for assessing how both models could perform in practice. The analysis on pooled specimens identified selected miRNAs as discriminatory for the categories analyzed. On individual serum samples, we showed that 15 miRNAs serve as signature for H and PTB categories with a diagnostic accuracy of 82% (CI 70.2-90.0), and 77% (CI 64.2-85.9) in a RVM and a logistic classification model, respectively. Considering the different ethnicity, by selecting the specific signature for the European group (10 miRNAs) the diagnostic accuracy increased up to 83% (CI 68.1-92.1), and 81% (65.0-90.3), respectively. The African-specific signature (12 miRNAs) increased the diagnostic accuracy up to 95% (CI 76.4-99.1), and 100% (83.9-100.0), respectively. Serum miRNA signatures represent an interesting source of biomarkers for TB disease with the potential to discriminate between PTB and LTBI, but also among the other categories.
    PLoS ONE 01/2013; 8(11):e80149. · 3.73 Impact Factor
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    ABSTRACT: BACKGROUND: Travel is thought to be a risk factor for the acquisition of sexually transmitted infections (STIs), but no multicentre analyses have been done. We aimed to describe the range of diseases and the demographic and geographical factors associated with the acquisition of travel-related STIs through analysis of the data gathered by GeoSentinel travel medicine clinics worldwide. METHODS: We gathered data from ill travellers visiting GeoSentinel clinics worldwide between June 1, 1996, and Nov 30, 2010, and analysed them to identify STIs in three clinical settings: after travel, during travel, or immigration travel. We calculated proportionate morbidity for each of the three traveller groups and did logistic regression to assess the association between STIs and demographic, geographical, and travel variables. FINDINGS: Our final analysis was of 112 180 ill travellers-64 335 patients seen after travel, 38 287 patients seen during travel, and 9558 immigrant patients. 974 patients (0·9%) had diagnoses of STIs, and 1001 STIs were diagnosed. The proportionate STI morbidities were 6·6, 10·2, and 16·8 per 1000 travellers in the three groups, respectively. STIs varied substantially according to the traveller category. The most common STI diagnoses were non-gonococcal or unspecified urethritis (30·2%) and acute HIV infection (27·6%) in patients seen after travel; non-gonococcal or unspecified urethritis (21·1%), epididymitis (15·2%), and cervicitis (12·3%) in patients seen during travel; and syphilis in immigrant travellers (67·8%). In ill travellers seen after travel, significant associations were noted between diagnosis of STIs and male sex, travelling to visit friends or relatives, travel duration of less than 1 month, and not having pretravel health consultations. INTERPRETATION: The range of STIs varies substantially according to traveller category. STI preventive strategies should be particularly targeted at men and travellers visiting friends or relatives. Our data suggest target groups for pretravel interventions and should assist in post-travel screening and decision making. FUNDING: US Centers for Disease Control and Prevention, and International Society of Travel Medicine.
    The Lancet Infectious Diseases 11/2012; · 19.97 Impact Factor
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    ABSTRACT: Evaluation of: Man MA, Nicolau D. Surgical treatment to increase the success rate of multidrug-resistant tuberculosis. Eur. J. Cardiothorac. Surg. 42, e9-e12 (2012). The global emergence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB represents a core challenge for global tuberculosis control. MDR-TB and extensively drug-resistant TB are more difficult to treat and have a worse outcome compared with drug-susceptible disease. Surgery has proved to improve treatment success in MDR-TB patients. This study was designed to assess the impact of surgery in a cohort of MDR-TB patients. The authors evaluate one of the largest cohorts treated by a single center, demonstrating that specialized thoracic surgery centers may achieve excellent results with a low rate of complications after surgery, and proposing an effective model of teamwork based on pulmonologists and surgeons. A review of the evidence supporting the role of surgery in addition to chemotherapy to improve treatment outcomes in difficult-to-treat cases of TB is also performed.
    Expert Review of Anticancer Therapy 10/2012; 10(10):1109-15. · 3.22 Impact Factor
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    ABSTRACT: With industrial development and expanding tourism, many people now have an opportunity to travel to many previously unreachable foreign destinations. Travelers with medical or physical conditions or who are vulnerable because of pregnancy or age (pediatric or elderly traveler), require specialist support and advice before traveling. Immigrants who return to their country of birth to visit relatives and friends should be classified as vulnerable travelers, as they have been shown to carry a disproportionate burden of travel-related morbidity. In this article, we explore the major risks to health and the main preventive strategies appropriate to the most vulnerable travelers.
    Infectious disease clinics of North America 09/2012; 26(3):625-35. · 2.29 Impact Factor
  • The Journal of allergy and clinical immunology 07/2012; · 12.05 Impact Factor
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    ABSTRACT: Malaria continues to be amongst the most frequent infectious diseases imported to Europe. Whilst European treatment guidelines are based on data from studies carried out in endemic areas, there is a paucity of original prospective treatment data. The objective was to summarize data on treatments to harmonize and optimize treatment for uncomplicated malaria in Europe. A prospective observational multicentre study was conducted, assessing tolerance and efficacy of treatment regimens for imported uncomplicated falciparum malaria in adults amongst European centres of tropical and travel medicine. Between December 2003 and 2009, 504 patients were included in 16 centres from five European countries. Eighteen treatment regimens were reported, the top three being atovaquone-proguanil, mefloquine, and artemether-lumefantrine. Treatments significantly differed with respect to the occurrence of treatment changes (p = 0.005) and adverse events (p = 0.001), parasite and fever clearance times (p < 0.001), and hospitalization rates (p = 0.0066) and durations (p = 0.001). Four recrudescences and two progressions to severe disease were observed. Compared to other regimens, quinine alone was associated with more frequent switches to second line treatment, more adverse events and longer inpatient stays. Parasite and fever clearance times were shortest with artemether-mefloquine combination treatment. Vomiting was the most frequent cause of treatment change, occurring in 5.5% of all patients but 9% of the atovaquone-proguanil group. This study highlights the heterogeneity of standards of care within Europe. A consensus discussion at European level is desirable to foster a standardized management of imported falciparum malaria.
    Malaria Journal 06/2012; 11:212. · 3.40 Impact Factor
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    ABSTRACT: We evaluated the association between human papillomavirus cervical infection and HIV shedding in cervicovaginal lavage fluid (CVL), studying 89 HIV-infected women recruited at the Department of Infectious Diseases of Brescia (Italy). HIV shedding in CVL was found in a similar proportion of women with (30%; 21/70) and without (31.6%; 6/19) cervical human papillomavirus infection. A statistically significant correlation was found between HIV viral load in serum and CVL among the 27 women with detectable HIV in CVL (r = 0.4; P = 0.04). However, women on highly active antiretroviral therapy were more likely to have detectable HIV-RNA in CVL despite negative viremia (80% vs. 8%; P < 0.005).
    JAIDS Journal of Acquired Immune Deficiency Syndromes 06/2012; 61(1):78-82. · 4.65 Impact Factor
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    ABSTRACT: To evaluate the pharmacokinetic profile of ritonavir-boosted lopinavir in HIV-infected patients during rifabutin-based anti-mycobacterial therapy. A longitudinal, cross-over pharmacokinetic evaluation of lopinavir with and without rifabutin in HIV-infected subjects with mycobacterial disease was done. All received lopinavir/ritonavir (400/100 mg twice a day) + an adjusted rifabutin dose of 150 mg every other day. Twelve-hour lopinavir pharmacokinetic sampling occurred at 2 weeks (T1) and 6 weeks (T2) after starting combined therapy and 10 weeks after completion of adjusted rifabutin (T3). Plasma was assayed using an HPLC method; lopinavir plasma concentration-time data were analysed using non-compartmental methods. In 10 patients with complete lopinavir curves at T1, T2 and T3 pharmacokinetic values were, respectively: AUC(0-12), 187.5, 161.8 and 121.1 μg · h/mL; C(trough), 13.2, 10.0 and 7.7 μg/mL; C(max), 18.7, 15.9 and 13.3 μg/mL; and apparent oral clearance (CL/F), 0.035, 0.037 and 0.045 L/h/kg. Lopinavir C(trough) and AUC(0-12) were significantly higher at T1 compared with T3 while CL/F remained unchanged throughout. Combined treatment was well tolerated and none of the patients experienced moderate to severe lopinavir-related adverse events. Lopinavir serum concentrations are not reduced when the drug is administered together with an adjusted dose of 150 mg of rifabutin every other day.
    Journal of Antimicrobial Chemotherapy 06/2012; 67(10):2470-3. · 5.34 Impact Factor
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    ABSTRACT: BACKGROUND: Pap screening, an effective method for cervical cancer prevention, is now supported by molecular human papillomavirus (HPV) testing. Recently commercialised preventive vaccines also provide new tools for the primary prevention of cervical cancer. To determine appropriate prevention strategies, the Health General Direction, Lombardy Region, funded a project that aims to characterize and monitor HPV infections and related cervical diseases in high-risk women. Methods/design VALHIDATE is a 5-year multicentre open prospective cohort study. It will recruit 7000 consenting women aged 13-65 years to provide information about the local biomolecular epidemiology of HPV infection and cervical diseases in high-risk women recruited from nine clinical centres and one faith-based organisation. The study will estimate the overall and type-specific prevalence of HPV infection and cervical abnormalities. It also aims to compare standard Pap screening with biomolecular screening, and to assist in the design of targeted regional prevention programs directed specifically at high-risk groups. Three groups of high-risk women: 1000 HIV-infected women (aged 26-65 years), 1000 recent migrant women (aged 26-65 years) and 3000 young women (aged 13-26 years) and 1 control group: 2000 women (aged 26-45 years) attending a spontaneous screening program, will be recruited. Sample sizes will be revised after the first year. Adult participants will undergo conventional cervical cytology, HPV DNA screening and genotyping. Paediatric participants will undergo HPV DNA testing and genotyping of urine samples. HPV DNA, cytological abnormalities and HPV types will be analysed according to demographic, epidemiological, behavioural, and clinical data collected in an electronic case report form. Overall and stratified prevalences will be estimated to analyse the associations between HPV infection and selected characteristics. Logistic regression models will be used to estimate crude and adjusted odds ratios. Cox proportional hazard models will be used to estimate hazard ratios over time and between groups. Discussion/main expected results This study will provide substantial insight into HPV infections and related cervical diseases in high-risk groups and will help determine appropriate regional cervical cancer prevention strategies. Study protocol: Sacco Hospital Ethical Committee resolution n35 (3rd Feb 2010), Sacco Hosp General Direction Resolution n174/2010 (9 March 2010).
    BMC Cancer 05/2012; 12(1):204. · 3.33 Impact Factor
  • European Respiratory Journal 05/2012; 39(5):1269-71. · 6.36 Impact Factor
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    ABSTRACT: This short version complies with the intention expressed in the methodological introduction to the full text Italian Guidelines for the use of antiretroviral drugs and the diagnostic-clinical management of people with HIV-1 infection. By definition, this version should not be considered completely exhaustive with respect to the full text version of the Guidelines available at the website: http://www.salute.gov.it/imgs/C_17_pubblicazioni_1301_allegato.pdf.
    The New Microbiologica: official journal of the Italian Society for Medical Virology (SIVIM) 04/2012; 35(2):113-59. · 1.67 Impact Factor
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    ABSTRACT: Antimicrobial susceptibilities and genotypes of Neisseria gonorrhoeae collected in 2006-2010 from 6 medical centers located in Italy were compared with those from a previous survey conducted in 2003-2005. Resistance to ciprofloxacin increased from 34.2% to 62% whereas penicillin resistance declined from 25.5% to 14%. Important change in antimicrobial resistance rates and a high genetic variability among N. gonorrhoeae from Italy were observed.
    Diagnostic microbiology and infectious disease 03/2012; 72(3):288-90. · 2.45 Impact Factor

Publication Stats

2k Citations
499.38 Total Impact Points

Institutions

  • 2009–2013
    • San Raffaele Scientific Institute
      Milano, Lombardy, Italy
  • 1994–2013
    • Università degli Studi di Brescia
      • Department of Clinical and Experimental Sciences
      Brescia, Lombardy, Italy
  • 2012
    • Galliera Hospital
      • Department of Infectious Diseases
      Genova, Liguria, Italy
  • 2010–2012
    • Ministère de la Santé du Burkina Faso
      Wagadugu, Centre, Burkina Faso
    • Boston Medical Center
      Boston, Massachusetts, United States
  • 2006–2012
    • Spedali Civili di Brescia
      Brescia, Lombardy, Italy
    • University of Udine
      Udine, Friuli Venezia Giulia, Italy
  • 2011
    • Fondazione Salvatore Maugeri IRCCS
      Ticinum, Lombardy, Italy
  • 2008–2009
    • Università degli Studi di Sassari
      Sassari, Sardinia, Italy
    • Azienda Ospedaliera San Carlo Borromeo Milano
      Milano, Lombardy, Italy
  • 2002
    • Hospital Universitário Clementino Fraga Filho
      Rio de Janeiro, Rio de Janeiro, Brazil
  • 1990
    • University of Pavia
      • Department of Public Health, Neuroscience, Experimental and Forensic Medicine
      Pavia, Lombardy, Italy