50 research outputs found
Successful antiviral treatment of chronic hepatitis C in patients with rare comorbidities. Two case-reports
No full textAntiviral therapy in patients suffering from chronic hepatitis C virus (HCV) infection and rare comorbidities cannot be easily started, as it can reduce the likelihood of a good therapeutic response with an increased frequency of side effects. We report two patients presenting unusual comorbidities associated with chronic C hepatitis: one with the Ehlers-Danlos Syndrome (EDS), a rare genetic disease caused by a defect in collagen synthesis, the other one with the Charcot Marie Tooth (CMT) disease, an uncommon but severe form of demyelinating peripheral neuropathy. Both patients were successfully treated with pegylated Interferon (Peg-IFN) and ribavirin (RBV) combined therapy, with the achievement of a sustained viral response (SVR) and a low occurrence of adverse effects. Up to now there are no reports of patients suffering from chronic C hepatitis associated with these uncommon but severe comorbidities treated with antiviral therapy. In conclusion, in such clinical situations, anti-HCV therapy may be started and tailored, especially if the patient is highly motivated and if optimal predictors of response (i.e. young age, favourable genotype and low baseline viraemia) do exist
Detection of Chlamydophila pneumoniae in patients with arthritis: Significance and diagnostic value
No full textThe aim of this study was to assess the potential clinical implications of Chlamydophila pneumoniae in patients with acute and chronic arthritic diseases and to investigate whether blood monocytes might reflect a concomitant synovial or persistent systemic infection. C. pneumoniae was investigated with advanced PCR and reverse transcriptase (RT) PCR techniques targeting different genes and combined with cell line cultures, in synovial fluid (SF) and peripheral blood mononuclear cell (PBMC) specimens collected from 28 patients with arthritis. Five out of twenty-eight patients (17.8%) were found to have C. pneumoniae DNA in either SF or PBMC specimens. Their diagnosis was reactive arthritis (ReA), S.A.P.H.O syndrome, psoriatic arthritis, undifferentiated oligoarthritis (UOA) and ankylosing spondylitis (AS). Specimens from patients with UOA and AS had also mRNA transcripts but those from AS yielded C. pneumoniae growth after co-culture. Moreover, C. pneumoniae DNA levels measured by Real-Time PCR (LightCycler) were higher in PBMC specimens compared to those found in SF at the end of antibiotic treatment. C. pneumoniae may have a role as triggering factor also in chronic arthritides including AS. The combined use of culture and molecular tools increases detection rates and improves the overall sensitivity, suggesting their potential use to detect C. pneumoniae. The different kinetics of bacterial DNA at both peripheral and synovial levels should be taken into consideration when monitoring and evaluating the effectiveness of antibiotic treatment. © 2010 Springer-Verlag
Endocrinological aspects of hypophosphatemia in HIV infection. Pilot study on Vitamin D supplementation: an observational study
No full textHIV clinical indicator diseases prior to HIV diagnosis are correlated to clinical progression in Late Presenters
No full textDepression and anxiety in HIV-infected patients compared to HIV-negative subjects: an observational study at Ferrara Hospital
No full textDisease Progression in HIV Late Presenters: the Role of HIV Clinical Indicator Diseases Prior to HIV Diagnosis
No full textLate diagnosis represents a major challenge in the control of HIV epidemics. The rate of disease progression is higher among late presenters. In Europe, HIV Clinical Indicator Diseases (CIDs) have been proposed to improve early diagnosis
HBsAg seroreversion in HBsAg-negative/HBcAb-positive patients with HIV infection treated with direct-acting antivirals for HCV: A retrospective study
No full textNo data on the risk of HBV reactivation in HCV-HIV co-infected patients undergoing DAAs have been published yet. According to international guidelines , all HIV-infected and HBsAg-positive patients should be treated with antiretroviral therapy (ART) containing nucleoside reverse transcriptase inhibitors (NRTI) dually active against HBV and HIV, such as tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF) plus lamivudine (3TC) or emtricitabine (FTC), with consequent no risk for HBV reactivation. However, there are not precise indications regarding HBsAg-negative and HBcAb-positive individuals with HIV infection (4.7%–12% of HIV population in Europe). To date, the risk of HBsAg seroreversion in HCV-HIV co-infected patients with HBsAg-negative and HBcAb-positive serology, treated with NRTI-sparing ARV regimens, and exposed to DAAs regimen, is not known. The authors retrospectively included all the HCV-HIV co-infected and HBsAg-negative/anti-HBc positive individuals, who started DAAs from October 2014 to September 2017 in Bologna. Since HBV DNA levels were not routinely measured at DAAs initiation, patients with undetectable or low HBV DNA viral load (VL) were indiscriminately included. the authors enrolled in the study 24 subjects, who met inclusion criteria. Two out of 24 patients (8.3%) developed HBsAg seroreversion during the observation period. Nowadays, DAAs regimens are widely used also among patients with HIV or with HBV coinfection. In the latter group, a risk of HBV reactivation has been reported of 21% in HBsAg positive and a risk of HBsAg seroreversion of 0.5% in HBsAg negative/HBcAb positive patients (all HIV-uninfected) treated with DAAs, by a recent metanalysis. In this study, the authors observed an unexpectedly high rate of 8% of HBsAg seroreversion among HCV-HIV co-infected subjects with HBsAg-negative/HBcAb-positive status.To our knowledge, this is the first study analyzing the risk for HBsAg seroreversion in HCV-HIV patients with isolated positive HBcAb serology who undergo DAA-regimens and receiving NRTI-sparing regimen for HIV. Such a high seroreversion rate (8.3%) was not reported before among patients with the same characteristics, but HIV-negative.
Our findings suggest that low CD4+-T cells nadir and history of AIDS might be potential risk factors for HBsAg seroreversion. Subjects with low CD4+-T cells nadir generally have a more compromised immune system even after they achieve good immunovirological control.
In conclusion, the results of this study suggest that people with HIV and HBsAg-negative/HBcAb-positive status receiving a NRTI-sparing ART might be at “high risk” for HBsAg seroreversion when treated with DAAs. Therefore, from our data one could recommend ART containing TDF, TAF, 3TC or FTC during DAAs treatment to prevent this potentially life-threatening event
Primo caso di riattivazione di tubercolosi durante trattamento con interferone peghilato in paziente con epatite cronica B
No full textLa Tubercolosi rappresenta un emergente problema di salute pubblica associato soprattutto ai flussi migratori. Le modificazioni della risposta immune cellulo-mediata, alla base della riattivazione dell’infezione da Mycobacterium tuberculosis e dello sviluppo della Malattia Tubercolare, possono presentarsi in numerose condizioni cliniche quali infezione de HIV, neoplasie, insufficienza d’organo, terapie farmacologiche. Il trattamento attuale di HBV si avvale di due possibili approcci: analoghi nucleotidici/nucleosidici (NUC) o interferone peghilato alfa 2a. Gli effetti secondari all’impiego di interferone sono molteplici: astenia, febbre, calo ponderale, disturbi neuropsichiatrici, disordini ematopoietici, alterazioni immunologiche (in particolare, riduzione della conta di linfociti CD4 e alterazioni citochiniche). Sebbene siano stati osservati casi di riattivazione di TB durante terapia interferonica (associata a ribavirina) in corso del trattamento di HCV, non sono invece noti quelli insorti durante trattamento di HBV. Descriviamo il primo caso di TB (linfonodale) insorta durante monoterapia con interferone per epatite B, in un paziente di origine cinese affetto da cirrosi epatica. Seguendo le attuali linee guida, non e’ stato effettuato nessuno screening per la TB prima della terapia interferonica, benchè il paziente provenisse da un paese ad elevata endemia. Dopo immediata sospensione dell’inteferone, il paziente veniva trattato con analogo nucleotidico (Tenofovir Disoproxil Fumarate) in associazione con la terapia standard anti-TB, con risoluzione della linfadenite e mantenimento della soppressione di HBV-DNA, senza effetti secondari di rilievo. Anche se i meccanismi della riattivazione di TB in corso di terapia inteferonica non sono chiari, l’attenta ricerca di un’infezione tubercolare latente e l’eventuale trattamento nei pazienti provenienti da aree endemiche, potrebbe trovare una razionale indicazione
Infezioni dell’osso e dei tessuti molli nelle fratture esposte. Approcci diagnostici e terapeutici.
No full textMENINGOENCEFALITE DA LISTERIA RESISTENTE AD AMPICILLINA E CARBAPENEMICO IN PAZIENTE IMMUNOCOMPETENTE
No full textPremessa. Listeria monocytogenes (Lm) è un patogeno ad elevato tasso di mortalità nelle gravide e neonati con possibile esito fatale anche nel soggetto immunocompetente. Eccettuati i rari report di resistenza clinica, Lm è sensibile ad Ampicillina (Amp) farmaco tuttora di 1° scelta per le infezioni da Listeria.
Obiettivo. Descriviamo un caso di meningoencefalite da Lm resistente ad Amp e Carbapenemico.
Risultati. Una donna di 52 anni, immunocompetente, affetta da epatite cronica HCV-relata non cirrogena, si reca in PS per febbre elevata, cefalea, vomito, stato confusionale, agitazione, strabismo. L’esame obiettivo evidenzia rigor nucalis, deficit VI nervo cranico sn, dolenzia addominale diffusa. Gli esami ematochimici mostrano piastrinopenia, monocitosi ed aumento indici di flogosi. E’ presente rabdomiolisi e disfunzione renale. La TC cerebrale rileva edema cerebrale diffuso, mentre la rachicentesi, liquor limpido (prevalente quota monocitaria e neutrofila), glico-clorurorrachia diminuite, proteinorrachia aumentata. La paziente viene trattata empiricamente con Ceftriaxone, Levofloxacina (LF), Acyclovir ed in seguito con Rifampicina (RIF). Dopo 12 h si riscontra Lm in colture liquorali per cui inizia Amp; tuttavia, 24 ore dopo, l’ antibiogramma (ABG) rileva ceppo resistente (R) a Penicillina (Pen), Amp, Meropenem (Mer), per cui ad LF e RIF si aggiungono TMP/STX e Linezolid (LIN). Dopo iniziale miglioramento (TC) compaiono, a distanza di 72 h, stato soporoso e idrocefalo triventricolare; si posiziona quindi derivazione ventricolare esterna, con miglioramento clinico-radiologico. L’ABG supplementare (Vitek-2 con pannello per Stafilococchi) conferma Pen-R, Amp-R (MIC confermata 2 volte con e-test) e Mer-R, sensibilità intermedia a LF, LIN, sensibilità (intermedia o altro??) a TMP/STX, RIF, Gentamicina (*bp EUCAST per Stafilococco ove non disponibili per Listeria). LIN ed TMP/STX sono stati sospesi al 10° giorno e dopo 3 settimane, rispettivamente; LF e RIF, dopo 5 settimane. La paziente viene dimessa ad un mese dall’esordio in buone condizioni. Dopo 4 mesi presenta esiti RMN stabili e lamenta sporadici episodi di amnesia.
Conclusioni. Ceppi di Listeria spp Amp-R mai segnalati da isolati umani, ambientali o alimentari fino al 1999, sono stati in seguito identificati nel cibo ed ambiente con trend di incremento di MIC nell’uomo. Nessun caso di Pen-R umano né resistenza ai carbapenemici erano stati finora documentati microbiologicamente. Due ceppi di Lm MDR sono stati isolati in Francia (1988 e 1990). Dal caso descritto si evidenzia che: 1) il consumo abbondante di formaggi e latticini non controllati alla fonte (Ucraina) per carenza di un’attenta sorveglianza alimentare, può aver favorito, considerata anche la sintomatologia addominale all’esordio, l’invasività del microrganismo, con interessamento del SNC; 2) un monitoraggio adeguato del profilo di resistenza agli antimicrobici diviene essenziale per determinare il trattamento adeguato, soprattutto in caso di resistenza all’Amp
