[Show abstract][Hide abstract] ABSTRACT: The surveillance of latent tuberculosis infection (LTBI) in both healthcare workers and healthcare students is considered fundamental for tuberculosis (TB) prevention. The aim of the present study was to estimate LTBI prevalence and evaluate potential risk-factors associated with this condition in a large cohort of medical students in Italy. In a cross-sectional study, performed between March and December 2012, 1511 eligible subjects attending the Medical School of the University of Genoa, trained at
the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the tuberculin skin test (TST). All the TST positive cases were confirmed with an interferon-gamma release assay (IGRA). A standardized questionnaire was collected for multivariate risk analysis.
A total of 1302 (86.2%) students underwent TST testing and completed the questionnaire. Eleven subjects (0.8%) resulted TST positive and LTBI diagnosis was confirmed in 2 (0.1%) cases. Professional exposure to active TB patients (OR 21.7, 95% CI 2.9–160.2; p value 0.003) and previous BCG immunization (OR 28.3, 95% CI 3.0–265.1; p value 0.003) are independently associated with TST positivity. Despite the low prevalence of LTBI among Italian medicalstudents, an occupational risk of TB infection still exists in countries with low circulation of Mycobacterium tuberculosis.
BioMed Research International 02/2015; 2015. · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dear Editor,Daptomycin use is increasing in clinical practice and in intensive care units due to both its concentration-dependent fast bactericidal activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus, and high vancomycin minimum inhibitory concentrations (MICs) . Standard recommended doses (4–6 mg/kg/day) are questioned in favor of higher ones (8–10 mg/kg/day), which could provide higher clinical and microbiological cure rates , overcome the augmented renal clearance in septic patients , and prevent the onset of antimicrobial non-susceptibility . Therapeutic failure due to the emergence of non-susceptible strains is documented in those infections characterized by high inoculum and deep-seated localizations, such as endocarditis or osteomyelitis, or in cases of standard-dose regimens . Furthermore, prior exposure to vancomycin is a recognized risk factor for decreased susceptibility to daptomycin due to induced changes on the ba ...
Intensive Care Medicine 12/2014; 41(2). · 5.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction. The European Regional Office of the World Health Organization developed a strategic approach to stop the indigenous transmission of measles in its 53 Member States by 2015. In Italy, laboratory surveillance activity is implemented by the National Reference Laboratory for Measles and Rubella at the Italian National Institute of Health (Istituto Superiore di Sanità, Rome). The role of the National Reference Laboratory is to strengthen surveillance systems through rigorous case investigation and laboratory confirmation of suspected sporadic cases and outbreaks. Genetic characterization of wild-type measles virus is an essential component of the laboratory-based surveillance. This study describes the molecular characterization of measles virus strains isolated during 2010.
Methods. Dried blood spots, urine and oral fluid samples were collected from patients with a suspected measles infection. Serological tests were performed on capillary blood, and viral detection was performed on urine and oral fluid samples through molecular assay. Positive samples were sequenced and phylogenetically analysed.
Results and discussion. The phylogenetic analysis showed a co-circulation of genotypes D4 and D8, and sporadic cases associated to genotypes D9 and B3. Then, molecular epidemiology of measles cases permitted to establish that D4 and D8 were the endemic genotypes in Italy during 2010.
[Show abstract][Hide abstract] ABSTRACT: Neuromuscular diseases (NMDs) encompass a broad spectrum of conditions. Because infections may be relevant to the final prognosis of most NMDs, vaccination appears to be the simplest and most effective solution for protecting NMD patients from vaccine-preventable infections. However, very few studies have evaluated the immunogenicity, safety, tolerability, and efficacy of different vaccines in NMD patients; therefore, detailed vaccination recommendations for NMD patients are not available. Here, we present vaccination recommendations from a group of Italian Scientific Societies for optimal disease prevention in NMD patients that maintain high safety levels. We found that NMD patients can be classified into two groups according to immune function: patients with normal immunity and patients who are immunocompromised, including those who intermittently or continuously take immunosuppressive therapy. Patients with normal immunity and do not take immunosuppressive therapy can be vaccinated as healthy subjects. In contrast, immunocompromised patients, including those who take immunosuppressive therapy, should receive all inactivated vaccines as well as influenza and pneumococcal vaccines; these patients should not be administered live attenuated vaccines. In all cases, the efficacy and long-term persistence of immunity from vaccination in NMD patients can be lower than in normal subjects. Household contacts of immunocompromised NMD patients should also be vaccinated appropriately.
[Show abstract][Hide abstract] ABSTRACT: Liguria, an administrative region in northern Italy characterized by a decade of high PCV coverage in paediatric age group, has issued new PCV13 recommendations for free active immunization in adults with risk factors and subjects aged ≥ 70 years old. Main aims of this study are: (1) a descriptive epidemiology of the clinical burden of lower respiratory tract infections (LRTI) in adults ≥18 years of age; and (2) a crossover evaluation of the effect of introduction of PCV13 vaccination in adults aged ≥70 years old, in terms of ED accesses for LRTI, obtained by a Syndrome Surveillance System (SSS). The ED access, chief complaint based SSS will allow an active surveillance of a population cohort of>430 000 individuals resident in Genoa metropolitan area, aged ≥18 years old, for a period of 60 months. During pre-PCV period, annual cumulative incidence of ED accesses for LRTI was equal to 7/1000 and 2% in ≥65 and ≥85 year adults, respectively. In ≥65 years adults, more than 70% of subjects identified by the SSS has at least one risk condition, with a peak of 87% in ≥85 year cohort. New Ligurian PCV13 recommendations can potentially reach more than 75% of ED accesses for LRTI. Data highlights the heavy impact of LRTI in terms of ED accesses, especially in the elderly and subjects with chronic conditions and the usefulness of SSS tool for monitoring PCV vaccination effect.
Human vaccines & immunotherapeutics. 08/2014; 11(1).
[Show abstract][Hide abstract] ABSTRACT: Influenza vaccination is a fundamental tool for the prevention of influenza in healthcare settings and its administration to healthcare workers (HCWs) is recommended in more than 40 countries including United States of America and many countries of the European Union. Despite these recommendations, the compliance of HCWs to influenza vaccination is largely inadequate in Italy. Since 2005/06 season, a comprehensive multifaceted intervention project aimed at increasing the seasonal influenza vaccination coverage rates among HCWs was performed at the IRCCS AOU San Martino IST teaching hospital in Genoa, Italy, the regional tertiary adult acute-care reference center with a 1300 bed capacity. Despite almost a decade of efforts, the vaccination coverage rates registered at our hospital steadily remain unsatisfactory and very distant by the minimum objective of 75% defined by the Italian Ministry of Health. During the last influenza season (2013/14), vaccination coverage rates by occupation type resulted 30% among physicians, 11% among nurses and 9% among other clinical personnel. Further efforts are necessary to prevent the transmission of influenza to patient and novel strategies need to be identified and implemented in order to increase the compliance of HCWs, particularly nurses, with the seasonal influenza vaccination.
Human Vaccines and Therapeutics 08/2014; 11(1). · 3.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the great successes achieved in the fields of virology and diagnostics, several difficulties affect improvements in hepatitis C virus (HCV) infection control and eradication in the new era. New HCV infections still occur, especially in some of the poorest regions of the world, where HCV is endemic and long-term sequelae have a growing economic and health burden. An HCV vaccine is still no available, despite years of researches and discoveries about the natural history of infection and host-virus interactions: several HCV vaccine candidates have been developed in the last years, targeting different HCV antigens or using alternative delivery systems, but viral variability and adaption ability constitute major challenges for vaccine development. Many new antiviral drugs for HCV therapy are in preclinical or early clinical development, but different limitations affect treatment validity. Treatment predictors are important tools, as they provide some guidance for the management of therapy in patients with chronic HCV infection: in particular, the role of host genomics in HCV infection outcomes in the new era of direct-acting antivirals may evolve for new therapeutic targets, representing a chance for modulated and personalized treatment management, when also very potent therapies will be available. In the present review we discuss the most recent data about HCV epidemiology, the new perspectives for the prevention of HCV infection and the most recent evidence regarding HCV diagnosis, therapy and predictors of response to it.
World journal of gastroenterology : WJG. 08/2014; 20(29):9633-9652.
[Show abstract][Hide abstract] ABSTRACT: Candida is the most common cause of severe yeast infections worldwide, especially in critically ill patients. In this setting, septic shock attributable to Candida is characterized by high mortality rates. The aim of this multicenter study was to investigate the determinants of outcome in critically ill patients with septic shock due to candidemia.
This was a retrospective study in which patients with septic shock attributable to Candida who were treated during the 3-year study period at one or more of the five participating teaching hospitals in Italy and Spain were eligible for enrolment. Patient characteristics, infection-related variables, and therapy-related features were reviewed. Multiple logistic regression analysis was performed to identify the risk factors significantly associated with 30-day mortality.
A total of 216 patients (mean age 63.4 ± 18.5 years; 58.3 % males) were included in the study. Of these, 163 (75 %) were admitted to the intensive care unit. Overall 30-day mortality was 54 %. Significantly higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, dysfunctional organs, and inadequate antifungal therapy were compared in nonsurvivors and survivors. No differences in survivors versus nonsurvivors were found in terms of the time from positive blood culture to initiation of adequate antifungal therapy. Multivariate logistic regression identified inadequate source control, inadequate antifungal therapy, and 1-point increments in the APACHE II score as independent variables associated with a higher 30-day mortality rate.
European Journal of Intensive Care Medicine 05/2014; 40(6). · 5.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nonadherence to recommended pneumococcal conjugate vaccine (PCV) schedules may have implications for protection against pneumococcal disease. In this commentary, we have assessed adherence to the recommended dosing schedules (the completion of the primary PCV and booster series) in different European countries. We found that adherence with the PCV schedule was lower than that for diphtheria-tetanus-acellular pertussis (DTaP) and that higher adherence was observed in countries where PCV vaccination is recommended and funded. Adherence with the booster dose is often lower than that with the primary series completion, and it is often given after the recommended age. These data highlight the need to encourage timely vaccination of children with PCV, in line with local immunization schedules. There is no single solution to improve adherence; actions need to be tailored to the context of individual countries through initiatives at the national, regional, and local levels and should target different stakeholders.
[Show abstract][Hide abstract] ABSTRACT: Neisseria meningitidis is an obligate human commensal which commonly colonizes the oropharyngeal mucosa. Carriage is age-dependent and very common in young adults. The relationships between carriage and invasive disease are not completely understood.In this work, we performed a longitudinal carrier study in adolescents and young adults (173 subjects). Overall, 32 subjects (18.5%) resulted positive to meningococcal carriage at least at one visit (average monthly carriage rate 12.1%). Only five subjects were positive at all four visits. All meningococcal isolates were characterized by molecular and serological techniques. Multilocus sequence typing, PorA typing and sequencing of the 4CMenB vaccine antigens were used to assess strain diversity. The majority of positive subjects were colonized by Capsule-null (34.4%) and by capsular group B strains (28.1%), accounting for 23.5% and 29.4% of the total isolates, respectively. Fhbp and nhba genes were present in all isolates, while nadA in 5% of the isolates. The genetic variability of the 4CMenB vaccine antigens in this collection was relatively high if compared with other disease-causing strain panels. Indications about the persistence of the carriage state were limited to the time span of the study. All strains isolated from the same subject were identical, or cumulated minor changes overtime. The expression levels and antigenicity of the 4CMenB vaccine antigens in each strain were analyzed by the meningoccoccal antigen typing system (MATS), and it revealed that expression can change overtime in the same individual. Future analysis of antigen variability and expression in carrier strains after the MenB vaccine introduction will allow to define its impact on naso/oropharyngeal carriage.
Journal of clinical microbiology 03/2014; · 4.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The morbidity and mortality related to many communicable infectious diseases have significantly decreased in Western countries largely because of the use of antibiotics, and the implementation of well-planned vaccination strategies and national immunisation schedules specifically aimed at infants and children. However, although immunisation has proved to be highly effective for public health, more effort is needed to improve the currently sub-optimal rates of vaccination against various diseases among adults who may be at risk because of their age, medical condition or occupation. The vaccines currently licenced in Western countries are safe, immunogenic and effective against many infectious diseases and their complications, but the availability of newer vaccines or vaccines with new indications, the evolving ecology and epidemiology of many infections, population ageing, and other demographic changes (i.e. the increasing prevalence of chronic comorbidities and immunodeficiencies, mass migration, new working relationships, and widespread international tourism) require changes in the approach to immunisation. There is now a need for appropriate preventive measures for adults and the elderly aimed at protecting people at risk by using every possible catch-up opportunity and recommending specific age-related schedules on the basis of local epidemiology.
European Journal of Internal Medicine 03/2014; · 2.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The alcoholic liver disease (ALD) is the leading cause of death from liver failure in Italy and worldwide. Ethanol abstention, a healthy diet, and a significant improvement of life-style are the mainstay of treatment for this disease. Currently, we do not have effective therapeutic options are at our disposal to restore and maintain an improved clinical status. Silymarin is a complementary and alternative medicine often prescribed and self-prescribed; it has anti-oxidant, anti-inflammatory, anti-fibrotic, and metabolic properties. It improves the laboratoristic values and the ultrasonographic grading of liver disease in case of steatosis/steatohepatitis. S-adenosyl-L-methionine (SAMe) is the principal biological methyl donor, and it is also a precursor of glutathione (GSH), essential for the anti-oxidant pathways. SAMe is particularly important for opposing the toxicity of free radicals generated by various toxins, including alcohol. An association between Silymarin and SAMe (labelled as a dietary supplement) has been recently brought to market, and seems to be promising. It could be beneficial in such cases of alcoholic hepathopathies. New therapeutic options are needed by hepatologists to successfully overcome a constantly growing disease.
Minerva gastroenterologica e dietologica 12/2013; 59(4):341-356.
[Show abstract][Hide abstract] ABSTRACT: We previously showed that long-lasting complete remission (CR) non-Hodgkin lymphoma (NHL) patients treated with rituximab-containing chemotherapy have an attenuated antibody response to virosomal (Bedognetti et al, J. Immunology, 2011) or MF-59 adjuvanted (Bedognetti et al, Blood, 2012) seasonal (or pandemic) influenza vaccine (as compared with healthy controls), associated with persistent CD27+ Memory B cell depletion and hypogamma-globulinemia. Here, we evaluated humoral and innate response to trivalent intradermal vaccination in NHL in CR previously treated with rituximab-containing che-motherapy (at least one year before vaccine administration), RIT group, and in CR cancer patients treated with chemotherapy without rituximab (at least one year before vaccine administration), Non-RIT group. Intradermal administration was chosen considering its promising data, compared to conventional intramuscular route, in terms of immunogenicity and safety. Humoral response was assessed by hemagglutinin inhibition assay on sera collected at time 0 (just before vaccination) and at time 28 (four weeks after vaccination). Innate response was assessed by whole-genome gene expression analysis (Affymetrix Humane Gene ST 1.0) on PBMC collected at time 0 and at time 1 (24 hours after vaccine administration). Patients treated with rituximab-containing che-motherapy had, overall, a lower antibody response, compared to patients treated with chemotherapy alone. Overall, intradermal vaccination induced dramatic changes in gene-expression profile already one day after vaccination. These changes underline the activation of IFN stimulated genes (eg, STAT1, STAT2, CXCL10, IDO1, GBP1) and modulation of NK-associated transcripts. In addition, pathway and gene-enrichment analysis show that RIT and non-RIT groups have different quantitative and qualitative transcriptomic changes 24 hours after vaccination administration. Concordantly with antibody-titer, the innate response was more intense in Non-RIT group compared with RIT group.
Society for Immunotherapy of Cancer 28th Annual Meeting; 11/2013
[Show abstract][Hide abstract] ABSTRACT: Viral respiratory tract infections (VRTI) are an important cause of morbidity and mortality in haematology patients, particularly after haematopoietic stem cell transplantation (HSCT). The incidence, clinical presentation and outcome of symptomatic and asymptomatic VRTI in HSCT outpatient unit were prospectively evaluated during a single influenza season (January-March 2011). Pharyngeal swabs were performed at the first visit and if new symptoms were present. Molecular multiplex assay for 12 respiratory viruses was performed by the regional reference laboratory. Among 264 swabs from 193 outpatients, 58 (22 %) resulted positive for 61 viruses (influenza, n = 20; respiratory syncytial virus [RSV], n = 21; rhinovirus, n = 12; coronavirus, n = 4; adenovirus, n = 3; parainfluenza, n = 1). VRTI were detected more frequently in the presence of symptoms than in asymptomatic patients: 49 out of 162 (30 %) vs. 9 out of 102 (9 %), p < 0.001. Influenza-like illness syndrome (ILI) was significantly associated with a VRTI if compared to other presentations (42 %), while the European Centre for Disease Prevention and Control definition was not (30 %). Positive predictive value (PPV) of ILI for influenza was 17 %. Influenza and RSV peak periods were contemporary. Influenza prophylaxis was given to 25 patients following exposure. Low rate of progression from upper to lower respiratory tract infection (approximately 5 % for influenza and RSV), no nosocomial epidemics and no VRTI-related deaths were observed. VRTI are very frequent in high-risk haematology outpatients, but symptoms are aspecific and PPV of ILI is low. Symptoms of influenza and RSV overlap. Thus, microbiological diagnosis and contact preventive measures are crucial. Rather than universal influenza prophylaxis, prompt diagnosis and treatment of only documented infections could be pursued.
Annals of Hematology 10/2013; · 2.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The screening of both healthcare workers and students attending teaching hospitals for latent tuberculosis infection (LTBI) is recommended in hospitals of many countries with a low-incidence of TB, including Italy, as a fundamental tool of tuberculosis (TB) control programs. The aim of the study was to estimate the prevalence of LTBI and evaluate the main risk-factors associated with this condition in a cohort of healthcare Italian students.
In a cross-sectional study, performed between January and May 2012, 881 undergraduate students attending the Medical, Nursing, Pediatric Nursing and Midwifery Schools of the University of Genoa, trained at the IRCCS San Martino-IST Teaching Hospital of Genoa, were actively called to undergo the Tuberculin Skin Test (TST). All the TST positive cases were also tested with an Interferon-Gamma Release Assay (IGRA) to confirm the diagnosis of LTBI. A standardized questionnaire was collected for risk-assessment analysis.
Seven hundred and thirty-three (83.2%) subjects underwent TST testing. The prevalence of TST positives was 1.4%, and in 4 (0.5%) out of 10 TST positive cases LTBI diagnosis was confirmed by IGRA. No difference in the prevalence of subjects who tested positive to TST emerged between pre-clinical (n = 138) and clinical (n = 595) students. No statistically significant association between TST positivity and age, gender, and BCG vaccination was observed. The main independent variable associated with TST positivity was to be born in a country with a high TB incidence (i.e., >=20 cases per 100,000 population) (adjusted OR 102.80, 95% CI 18.09-584.04, p < 0.001).
The prevalence of LTBI among healthcare students resulted very low. The only significant association between TST positivity and potential risk factors was to be born in high TB incidence areas. In countries with a low incidence of TB, the screening programs of healthcare students before clinical training can be useful for the early identification and treatment of the sporadic cases of LTBI.
[Show abstract][Hide abstract] ABSTRACT: Systemic lupus erythematosus (SLE) is a chronic immune-mediated inflammatory multisystem disease. The onset of viral and bacterial infections may favor the exacerbation of the disease, amplify autoimmune processes and contribute to mortality and morbidity. The prevention of influenza and Streptococcus pneumoniae infections with vaccination should receive particular attention in SLE patients considering their elevated incidence, their high attack rate in epidemic periods, their potentially severe complications as well as the immunocompromised state of the host. The use of non-adjuvanted vaccine preparations should be preferred in order to avoid the onset of the "Autoimmune (auto-inflammatory) Syndrome Induced by Adjuvants" or "ASIA". In this review, we report that influenza and pneumococcal vaccination in SLE patients are: 1) recommended to reduce the risk of development of these infections; 2) strongly suggested in elderly subjects and in those receiving high dose immunosuppressive treatments; 3) efficacious, even if specific immune responses may be lower than in the general population, as generally the humoral response fulfills the criteria for vaccine immunogenicity; 4) safe in inactive disease although may favour a transient increase in autoantibody levels and rarely disease flares.
[Show abstract][Hide abstract] ABSTRACT: This clinical driven report describes the unexpected detection of a multidrug resistant (MDR)Streptococcus pneumoniae strain. Italy is usually considered a country characterized by a low prevalenceof MDR )S. pneumoniae. We describe the occurrence of bacterial meningitis sustained by a MDR S.pneumoniae strain in Italy. The first-line treatment was started with ceftriaxone and dexamethasone, butafter the identification of such a resistant strain a second-line regimen was needed. The new regimen waschosen on both susceptibility and pharmacokinetic criteria. Linezolid and levofloxacin were started and adramatic improvement was observed. A more sensitive anamnesis revealed some elements known to beassociated to a MDR S. pneumoniae occurrence (immunesuppression, former antibiotic therapy). So thiscase should pinpoint our attention on risk factors of MDR for a careful choice of antibiotic therapy in seriouspneumococcal infections.
Journal of chemotherapy (Florence, Italy) 08/2013; · 0.83 Impact Factor