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1.
Infez Med ; 22(3): 193-9, 2014 Sep.
Article in Italian | MEDLINE | ID: mdl-25269960

ABSTRACT

HIV infection is commonly associated with emotional and cognitive disorders that recognize both causes of an organic nature (related to the virus itself) and non-organic factors (emotional stress resulting from HIV diagnosis, social stigma and continued risk behaviour such as alcohol or drug abuse). Most of the literature has focused attention on depressive disorder, the most common mental disorder in the HIV population. In our analysis we evaluated the presence of personality disorders and alexithymia in a group of patients seropositive for HIV through appropriate psychological tests. Our data revealed a close relationship between socio-emotional alienation, distorted body perception and the difficulty in relating with each other, which is perceived as threatening and judgmental; this concept takes us back to the social stigma that modifies the emotional communication of HIV patients. The illness is experienced as an outsider that modifies the body, imprisons the emotionalism and cannot be controlled. Such personality alterations stop the emotional communication, thereby developing alexithymia.


Subject(s)
Affective Symptoms/etiology , Depression/etiology , HIV Infections/complications , HIV Infections/psychology , Personality Disorders/etiology , Social Alienation , Adult , Aged , Female , Humans , Male , Middle Aged
2.
Antimicrob Agents Chemother ; 58(1): 414-8, 2014.
Article in English | MEDLINE | ID: mdl-24189252

ABSTRACT

The treatment of visceral leishmaniasis (VL) is poorly standardized in Italy in spite of the existing evidence. All consecutive patients with VL admitted at 15 Italian centers as inpatients or outpatients between January 2004 and December 2008 were retrospectively considered; outcome data at 1 year after treatment were obtained for all but 1 patient. Demographic characteristics, underlying diseases, diagnostic procedures, treatment regimens and outcomes, as well as side effects were recorded. A confirmed diagnosis of VL was reported for 166 patients: 120 (72.3%) immunocompetent, 21 (12.6%) patients with immune deficiencies other than HIV infection, and 25 (15.1%) coinfected with HIV. Liposomal amphotericin B (L-AmB) was the drug almost universally used for treatment, administered to 153 (92.2%) patients. Thirty-seven different regimens, including L-AmB were used. The mean doses were 29.4 ± 7.9 mg/kg in immunocompetent patients, 32.9 ± 8.6 mg/kg in patients with non-HIV-related immunodeficiencies, and 40.8 ± 6.7 mg/kg in HIV-infected patients (P < 0.001). The mean numbers of infusion days were 7.8 ± 3.1 in immunocompetent patients, 9.6 ± 3.9 in non-HIV-immunodeficient patients, and 12.0 ± 3.4 in HIV-infected patients (P < 0.001). Mild and reversible adverse events were observed in 12.2% of cases. Responsive patients were 154 (93.3%). Successes were 98.4% among immunocompetent patients, 90.5% among non-HIV-immunodeficient patients, and 72.0% among HIV-infected patients. Among predictors of primary response to treatment, HIV infection and age held independent associations in the final multivariate models, whereas the doses and duration of L-AmB treatment were not significantly associated. Longer treatments and higher doses of L-AmB were not able to significantly modify treatment outcomes either in the immunocompetent or in the immunocompromised population.


Subject(s)
Leishmaniasis, Visceral/drug therapy , Adolescent , Adult , Aged , Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Child , Female , Humans , Italy , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young Adult
3.
Infez Med ; 20(2): 120-4, 2012 Jun.
Article in Italian | MEDLINE | ID: mdl-22767312

ABSTRACT

In developing countries, tuberculosis (TBC) is commonly associated with inadequate socio-economic and sanitary conditions. Currently, in Western countries, TBC is often linked with HIV infection, an ageing population or trans-global migration. Approximately two out of ten TB cases worldwide are extra-pulmonary, of which abdominal tuberculosis accounts for 11%-16%. The Mycobacterium tuberculosis complex involves the abdomen as primary or secondary localization (hematogenous spread or from pulmonary foci or infected neighbouring organs). Abdominal TBC can infect the gastrointestinal tract, peritoneum, mesentery, abdominal lymph nodes, liver, spleen, and pancreas. Diagnosis of abdominal tuberculosis is difficult because of vague and non-specific clinical features and due to the differential diagnosis with other granulomatous diseases such as Crohn's Disease. It is of great importance for clinicians to pay great attention to tubercular aetiology as a possible cause of gastrointestinal symptoms. Here we describe the clinical case of a young immigrant patient with intestinal TB for whom the wrong initial diagnosis led to a delay in the correct diagnosis and a worsening of the already serious general conditions.


Subject(s)
Anus Diseases/diagnosis , Emigrants and Immigrants , Ileal Diseases/diagnosis , Tuberculosis, Gastrointestinal/diagnosis , Abdomen, Acute/etiology , Antitubercular Agents/therapeutic use , Anus Diseases/drug therapy , Anus Diseases/microbiology , Anus Diseases/surgery , Combined Modality Therapy , Constriction, Pathologic , Disease Progression , Humans , Ileal Diseases/diagnostic imaging , Ileal Diseases/drug therapy , Ileal Diseases/microbiology , Ileal Diseases/surgery , Ileocecal Valve , Male , Morocco/ethnology , Mycobacterium tuberculosis/isolation & purification , Osteolysis/drug therapy , Osteolysis/etiology , Peritonitis, Tuberculous/drug therapy , Peritonitis, Tuberculous/etiology , Peritonitis, Tuberculous/surgery , Thoracic Vertebrae , Tomography, X-Ray Computed , Tuberculosis, Gastrointestinal/complications , Tuberculosis, Gastrointestinal/diagnostic imaging , Tuberculosis, Gastrointestinal/drug therapy , Tuberculosis, Gastrointestinal/surgery , Tuberculosis, Osteoarticular/diagnosis , Ultrasonography , Yersinia Infections/complications , Yersinia Infections/drug therapy , Yersinia enterocolitica/isolation & purification , Young Adult
4.
Int J Infect Dis ; 14(4): e283-91, 2010 Apr.
Article in English | MEDLINE | ID: mdl-19656712

ABSTRACT

HIV and tuberculosis (TB) are leading global causes of mortality and morbidity. Highly active antiretroviral therapy (HAART) is often initiated in patients being treated for TB. The immune recovery associated with HAART results in dramatic clinical benefits, but this restoration of immunity may result in immunopathological reactions. The immune reconstitution inflammatory syndrome can result in fever, nodal enlargement, and worsening pulmonary infiltrates observed on a chest radiograph, with or without recurrent respiratory symptoms. Several other manifestations have also been described. As a consequence, the use of HAART might not be appropriate during the first weeks of anti-TB therapy in HIV-infected patients. In this review, we summarize the incidence, clinical presentations, and potential mechanisms of these conditions and we describe therapeutic methods.


Subject(s)
Immune Reconstitution Inflammatory Syndrome/microbiology , Mycobacterium tuberculosis/immunology , Tuberculosis/immunology , Anti-Inflammatory Agents/therapeutic use , Antitubercular Agents/therapeutic use , Female , Humans , Immune Reconstitution Inflammatory Syndrome/drug therapy , Immune Reconstitution Inflammatory Syndrome/immunology , Male , Tuberculosis/drug therapy
5.
New Microbiol ; 32(2): 223-7, 2009 Apr.
Article in English | MEDLINE | ID: mdl-19579705

ABSTRACT

Visceral Leishmaniasis (VL) is a vector-borne zoonosis endemic in Southern Italy whose usual clinical features include fever, splenomegaly, pancytopenia and hypergammaglobulinemia. The clinical and biochemical picture may be misleading in patients with immunodeficiency diseases hampering the diagnosis. We describe a VL case in a patient whose spleen had been removed and who had Common Variable Immunodeficiency and Evans syndrome.


Subject(s)
Anemia, Hemolytic, Autoimmune/complications , Common Variable Immunodeficiency/complications , Leishmaniasis, Visceral/etiology , Thrombocytopenia/complications , Amphotericin B/administration & dosage , Anemia, Hemolytic, Autoimmune/drug therapy , Antiprotozoal Agents/administration & dosage , Common Variable Immunodeficiency/therapy , Fever , Glucocorticoids/administration & dosage , Humans , Immunization, Passive , Immunocompromised Host , Leishmaniasis, Visceral/drug therapy , Leishmaniasis, Visceral/physiopathology , Male , Middle Aged , Prednisone/administration & dosage , Splenectomy , Thrombocytopenia/surgery
6.
New Microbiol ; 32(4): 415-7, 2009 Oct.
Article in English | MEDLINE | ID: mdl-20128450

ABSTRACT

Highly active antiretroviral therapy (HAART) has been shown to induce a major and durable viral load reduction accompanied by a stable CD4 increase. This process may evolve with adverse clinical phenomena, known as the immune reconstitution inflammatory syndrome (IRIS). In the HIV population, non-tuberculous mycobacteria are a common cause of IRIS. However, only a few cases of Mycobacterium xenopi associated IRIS have been described. This paper concerns a case of M. xenopi pulmonary infection resulting in self-limited immune reconstitution inflammatory syndrome in an HIV-1 infected patient.


Subject(s)
HIV Infections/complications , Immune Reconstitution Inflammatory Syndrome/etiology , Lung Diseases/complications , Mycobacterium Infections, Nontuberculous/complications , Mycobacterium xenopi , AIDS-Related Opportunistic Infections/immunology , AIDS-Related Opportunistic Infections/virology , Adult , Antiretroviral Therapy, Highly Active , HIV Infections/drug therapy , HIV Infections/immunology , HIV Infections/virology , HIV-1 , Humans , Lung Diseases/immunology , Lung Diseases/microbiology , Male , Mycobacterium Infections, Nontuberculous/immunology , Mycobacterium Infections, Nontuberculous/microbiology , Mycobacterium xenopi/isolation & purification
7.
Infez Med ; 16(1): 15-20, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18367878

ABSTRACT

The authors used ultrasonography to measure carotid artery intima-media thickness in a cohort of antiretroviral-experienced patients. Overall, 52 patients were enrolled in the study. Twenty-two patients (42.3%) showed a IMT > 1 mm and among these 14 (26.9%) showed a atheromatous plaque. Data analysis showed that IMT > 1 mm was associated with the duration of HIV infection (p 0.03), nadir CD4 cell count (p < 0.01), and conventional cardiovascular risk factors. No association was found between IMT and type or duration of antiretroviral therapy. These data confirm the direct role of HIV in the development of endothelial damage.


Subject(s)
Antiretroviral Therapy, Highly Active , Carotid Arteries/pathology , HIV Infections/drug therapy , Tunica Intima/pathology , Tunica Media/pathology , Adult , Female , Humans , Male
8.
Infez Med ; 15(4): 256-61, 2007 Dec.
Article in English | MEDLINE | ID: mdl-18162737

ABSTRACT

Myxoma is the most common type of cardiac tumour in all age groups. It may simulate infective endocarditis but is rarely infected. We describe one case of infected left atrial myxoma caused by Enterococcus faecalis. Combined therapy, consisting of surgical management and antimicrobial therapy, was used. Histological examination of the excised tumour revealed a typical myxoma with infiltrates of neutrophils. Few cases of infected atrial myxomas have been reported in the literature.


Subject(s)
Bacteremia/complications , Endocarditis, Bacterial/etiology , Enterococcus faecalis/isolation & purification , Gram-Positive Bacterial Infections/etiology , Heart Atria/microbiology , Heart Neoplasms/complications , Myxoma/complications , Aged , Aminoglycosides/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteremia/microbiology , Drug Resistance, Multiple, Bacterial , Enterococcus faecalis/drug effects , Female , Fever/etiology , Heart Atria/diagnostic imaging , Heart Atria/pathology , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , Humans , Myxoma/diagnostic imaging , Myxoma/surgery , Ultrasonography
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