1,721,147 research outputs found
Trombiculiasis: an underreported ectoparasitosis in Sicily
No full textTrombiculiasis is a common but underreported ectoparasitosis characterized by an infestation of the skin by the larval stage of various species of mites belonging to the phylum Arthropoda, class Arachnida, subclass Acarina. Clinical manifestations consist of pruritic erythematous and urticarial macules and papules located on covered thin and glabrous skin. In recent studies Neotrombicula autumnalis larvae have been described as the possible vectors of pathogens such as Borrelia burgdorferi and Anaplasma phagocytophilum. Few reports of trombiculosis have been collected in the medical literature to date. We report a typical case of trombiculosis induced by trombiculid larvae of N. autumnalis, which are habitual parasites of various endo- and ectothermic vertebrates
Rickettsiales in the WHO European Region: an update from a One Health perspective
Full text linkBACKGROUND: The availability of molecular techniques has significantly increased our understanding of bacteria of the order Rickettsiales, allowing the identification of distinct species in both vector and host arthropods. However, the literature lacks studies that comprehensively summarize the vast amount of knowledge generated on this topic in recent years. The purpose of this study was to conduct a comprehensive analysis of the distribution of Rickettsiales in arthropod vectors, animals and humans in the WHO European Region in order to provide useful information to predict the emergence of certain diseases in specific geographical areas and to formulate hypotheses regarding the possible pathogenetic role of some rickettsial species in the etiology of human pathological conditions. METHODS: A systematic review of the literature in the PubMed and EMBASE databases was conducted following the PRISMA methodology using the search terms “Spotted fever” OR “rickettsiosis” OR “ricketts*” AND all the countries of the WHO European Region, from 1 January 2013 to 12 February 2022. Only studies that identified rickettsiae in human, animal or arthropod samples using molecular techniques were included in the review. RESULTS: A total of 467 articles considering 61 different species of Rickettsiales with confirmed or suspected human pathogenicity were analyzed in the review. More than 566 identifications of Rickettsiales DNA in human samples were described, of which 89 cases were assessed as importation cases. A total of 55 species of ticks, 17 species of fleas, 10 species of mite and four species of lice were found infected. Twenty-three species of Rickettsiales were detected in wild and domestic animal samples. CONCLUSION: The routine use of molecular methods to search for Rickettsiales DNA in questing ticks and other blood-sucking arthropods that commonly bite humans should be encouraged. Molecular methods specific for Rickettsiales should be used routinely in the diagnostics of fever of unknown origin and in all cases of human diseases secondary to an arthropod bite or animal contact. GRAPHICAL ABSTRACT: [Image: see text] SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13071-022-05646-4
Fever with spontaneous gingival bleeding: A diagnostic challenge
Full text linkA previously healthy 4-year-old girl was admitted to our institution
with fever and painless spontaneous gingival bleeding, persisting over a
week, without evident lesions or trauma. She was born in Italy and had
always lived in Palermo. She had never travelled internationally. Lab oratory testing showed a negative swab test for Sars-CoV2 and a tri linear pancytopenia with neutropenia (0.6 × 103/mm3), lymphopenia
(1.17 × 103/mm3), thrombocytopenia (115 × 103/mm3) and anemia
(Hb 7.1 g/dL, RBC 3.48 × 103/mm3, Hct 21.2%, RDW-CV 23.4%, RDW SD 51,6 fL). Other laboratory findings showed hyponatremia (130
mmol/dL), hypocalcemia (8.7 mmol/dL), hypoalbuminemia (3.5 g/dL),
increase of LDH (267 IU/L), C-reactive protein (1.64 mg/dL) and alka line phosphatase levels (190 IU/L). On physical examination she
appeared in pain, pale, with hyperemic pharynx without plaque or pu rulent secretion and hypertrophic bleeding gingiva (see Fig. 1). There
was notable cervical lymphadenopathy, hepatomegaly (1 cm below the
costal margin), and splenomegaly (3 cm below the costal margin). An
abdominal ultrasound showed an enlarged spleen (15.6 × 6.6 cm) and
ascites.
Additional history revealed the diagnosis of visceral leishmaniasis,
treated with six doses of Amphotericin B liposomal (administered for
first 5 days plus one dose on the 10th day) seven months earlier. A
subsequent leishmania polymerase chain reaction (PCR) assay on blood
and gingival brush confirmed the diagnosis of a leishmaniasis relapse. A
comprehensive immunological evaluation including an HIV test
excluded any primary or acquired immunodeficiency disease. Treatment
with amphotericin B was administered over 10 days, leading to a full
recovery. Visceral leishmaniasis caused by Leishmania infantum is
endemic in the Mediterranean region. Mucocutaneus lesions are
extremely rare with this species and usually affect immunosuppressed
patients. In children leishmaniasis relapse with atypical mucosal
involvement represent a rarity. Clinical follow up and periodic PCR tests
(performed at 3-6-9-12 months after treatment) should be considered for
early recognition of a relapse
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Evaluating monocyte distribution width in pediatric emergency care
No full textBackground: Pediatric sepsis remains a major global health challenge, complicated by age-related variability in presentation and diagnostic uncertainty. Monocyte Distribution Width (MDW), a measure of monocyte anisocytosis automatically reported with complete blood count, has shown promise as an early biomarker for sepsis in adults. However, its clinical utility in pediatric patients remains unclear. In this study, we explored the usefulness of MDW in pediatric patients presenting to the emergency department (ED). Methods: We conducted a retrospective observational study of pediatric patients (<18 years) who presented to the ED for any cause. Patients were categorized into four groups: controls (no infection), infection, sepsis, and shock. MDW values were compared across groups and stratified by age (≤6 years and > 6 years). A receiver operating characteristic (ROC) curve analysis was performed to assess MDW diagnostic performance. Results: A total of 393 patients were enrolled: 117 controls, 183 with infection, 88 with sepsis, and 5 with shock. Overall, MDW values increased with disease severity, peaking in patients with shock. However, significant overlap was observed between infection and sepsis groups, particularly in children ≤ 6 years, where MDW was elevated even in controls. In children > 6 years, MDW showed a clearer stepwise increase across disease categories. ROC analysis revealed an AUC of 0.73 for distinguishing infected from non-infected patients at a cutoff of 24. Conclusions: MDW is a readily accessible biomarker that may aid in identifying pediatric patients with infection in emergency settings
Aortic Stiffness in HIV Infection with and without Antiretroviral Therapy. A Meta-analysis of Observational Studies
Full text linkBackground: The risk of Cardiovascular (CV) events is higher in HIV-infected patients (HIV+) compared to HIV-uninfected
persons (HIV−). Large artery stiffness, a well-documented predictor of adverse CV prognosis, may mediate this enhanced risk.
It is usually assessed by measuring aortic Pulse Wave Velocity (aPWV). Studies examining arterial stiffness in HIV+ yielded
inconsistent results. We performed a meta-analysis with the aim to evaluate the association of HIV infection and its therapy
[Antiretroviral Therapy (ART)] with aPWV.
Design and Method: The Standardized Mean Difference (SMD) and corresponding 95% confidence intervals were calculated
for aPWV in different comparison groups. Statistical heterogeneity, assessed by Q-test and I2 statistic, was observed in all these
comparisons. Therefore, random effects model was implemented.
Results: In a total of 12 studies, naive HIV+ (n = 547) showed increased aPWV compared to HIV− (n = 864): SMD = 0.333
(0.125–0.542), p < 0.002. A total of 22 studies were identified comparing HIV+ treated with ART (n = 3348) to HIV− (n = 2547)
showing higher values of aPWV in the former than in latter: SMD = 0.391 (0.225–0.556), p < 0.001. In 10 studies, HIV+ treated
with ART (n = 761) exhibited greater aPWV values than those of naive HIV+ (n = 457): SMD = 0.262 (0.006–0.518), p = 0.045.
Conclusion: Our meta-analysis seems to suggest that HIV infection “per se” and ART may impair aortic distensibility. However,
interpretation of our results needs caution due to between-study heterogeneity and some potential publication biase
A case of disseminated BCG infection in a daughter of Italian immigrants in Switzerland
Full text linkBacillus Calmette-Guerin (BCG) is a vaccine against tuberculosis and contains a live, attenuated strain of Mycobacterium bovis as its essential constituent. Being a live, attenuated strain with potential pathogenicity, BCG can cause different complications, both near the inoculation site and through blood dissemination, especially in patients with immunodeficiency. IFN-gamma R1 deficiency is an autosomal recessively inherited immunodeficiency characterized by predisposition to infections with intracellular pathogens, in particular mycobacteria. We report a rare case of chronic osteomyelitis lasting 30 years due to BCG in a woman with IFN-gamma R1 deficiency who had previous clinical history of multi-organ BCGitis. Diagnosis of chronic osteomyelitis was confirmed by an 18-fluorine fluorodeoxyglucose positron emission tomography combined with CT scan (18F-FDG PET/CT). In children with a history of BCG vaccination and chronic unexplained infections, a clinical suspicion of BCG-related disease must arise, and a reason of immunodeficiency should be sought
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