Subject(s)
Cat-Scratch Disease/diagnosis , Liver Diseases/diagnosis , Lymphadenitis/diagnosis , Opportunistic Infections/diagnosis , Splenic Diseases/diagnosis , Adolescent , Bartonella henselae , Cat-Scratch Disease/therapy , Early Diagnosis , Female , Humans , Liver Diseases/therapy , Lymphadenitis/therapy , Opportunistic Infections/therapy , Splenic Diseases/therapySubject(s)
Anti-HIV Agents/poisoning , Brain/drug effects , HIV Infections/prevention & control , Oxazines/poisoning , Alkynes , Benzoxazines , Cyclopropanes , Drug Overdose , Female , Humans , Medication Errors , Middle Aged , Needlestick Injuries/complications , Occupational Diseases/complicationsABSTRACT
The Authors report on the use of linezolid for the treatment of three patients with osteomyelitis. All three patients had post-traumatic multisensitive hand bone methicillin-susceptible Staphylococcus aureus osteomyelitis, which did not respond to antimicrobial regimens including drugs in vitro active against the isolated strains. Clinical cure and microbiologic eradication was obtained with oral linezolid in all three patients. Linezolid was well tolerated. Mild thrombocytopenia was observed in one patient at the end of the third week of treatment and it was promptly resolved after the discontinuation of linezolid. Linezolid minimum inhibitory concentrations (MICs) consisted of 2 mg/l for all three S. aureus isolates while the bactericidal activity in vitro was not present up to the linezolid concentration of 32 mg/l. In spite of a lack of in vitro bactericidal activity, linezolid was effective in curing the patients and eradicating the infection. Trough and peak plasma concentrations of linezolid were above the MICs of the isolates. These values ranged from 3.93 to 14.95 mg/l at trough and 5.03 to 25.91 mg/l at peak. The oral bioavailability, pharmacokinetic profile and antibacterial spectrum of linezolid make this oxazolidonone antimicrobial an attractive drug for the treatment of chronic osteomyelitis. Prolonged administration requires careful surveillance for side effects, until these complications are better understood.
Subject(s)
Acetamides/therapeutic use , Anti-Infective Agents/therapeutic use , Finger Injuries/complications , Osteomyelitis/drug therapy , Oxazolidinones/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Acetamides/pharmacokinetics , Administration, Oral , Aged , Anti-Infective Agents/pharmacokinetics , Biological Availability , Chronic Disease , Diabetes Complications , Humans , Linezolid , Male , Microbial Sensitivity Tests , Middle Aged , Osteomyelitis/etiology , Oxazolidinones/pharmacokinetics , Staphylococcal Infections/etiology , Staphylococcus aureus/drug effectsABSTRACT
BACKGROUND: An early virological response to interferon-alpha treatment is a strong predictor of sustained response, but it has never been exploited to stratify patients in clinical trials. AIM: To evaluate the efficacy of amantadine plus interferon-alpha compared with interferon-alpha alone in naive patients with chronic hepatitis C who were randomized on the basis of the early virological response to interferon-alpha. METHODS: One hundred and eighty-one patients received recombinant interferon-alpha2a (3 MU three times weekly) for 2 months and 164 were evaluated for early (i.e. month 2) virological response. Hepatitis C virus (HCV) RNA-negative patients (n = 66) were randomized to receive 3 MU of interferon-alpha three times weekly, with or without amantadine (200 mg/day); HCV RNA-positive patients (n = 98) were randomized to receive 6 MU of interferon-alpha three times weekly, with or without amantadine (200 mg/day). HCV RNA-positive patients at 6 months discontinued treatment, and all others completed 12 months. RESULTS: At month 6, HCV RNA-negative patients made up 54.2% of the interferon + amantadine group and 42.0% of the monotherapy group (P = 0.07). At month 12, HCV RNA-negative patients made up 38.5% of the interferon + amantadine group and 28.4% of the monotherapy group (N.S.). The sustained virological response rates were 21.6% and 20.9%, respectively (N.S.). CONCLUSION: The addition of amantadine does not enhance the sustained virological response to interferon-alpha in naive patients with chronic hepatitis C; however, an additive effect of amantadine occurs in the first 6 months, mainly in patients without an early response to monotherapy. Early response to interferon-alpha is a strong predictor of sustained virological response.
Subject(s)
Amantadine/therapeutic use , Antiviral Agents/therapeutic use , Hepatitis C, Chronic/drug therapy , Interferon-alpha/therapeutic use , Adolescent , Adult , Aged , Drug Combinations , Female , Humans , Interferon alpha-2 , Male , Middle Aged , Recombinant Proteins , Treatment OutcomeABSTRACT
We describe two cases of dengue fever (DF) serologicaly confirmed. In both, the clinical features are characterized by: fever, severe headache, myalgias and arthalgias, transient macule-papule rash, leukopenia and thrombocytopenia. The entire illness last few days and terminates abruptly without therapy. A history of travel to dengue-endemic areas and occurrence of other cases in a community are important reminders to include this disease in the differential diagnosis. The hemoagglutination inhibition test for DF at the Laboratory of Virology of the Istituto Superiore di Sanità on two collected sera, during the acute and convalescent phases, has showed a seroconversion. A problem is to advise patients to avoid endemic areas because the second exposure could induce DHF/dengue shock syndrome.
Subject(s)
Dengue/diagnosis , Travel , Adult , Hemagglutination Tests/methods , Humans , MaleABSTRACT
We studied the prevalence, clinical spectrum and epidemiologic features of thrombocytopenia among 442 (333 male, 109 female) HIV infected patients. Thrombocytopenia was defined as a platelet count < 100,000/mmc and severe if platelet count was < or = 30,000/mmc. Intravenous drug abusers were 83% (369/442). At the first clinical evaluation according to Walter-Reed (WR) classification, 90% (396/442) of patients were in stage 1-5 and 10% (45/442) in stage 6. Severe thrombocytopenia (platelet count < or = 30,000/mmc) was present in 24% (11/45) of the entire thrombocytopenic population. Forty percent (18/45) of the thrombocytopenic patients were positive to: HBV (6), HCV (7), HBV+HCV (5). Mild bleeding was present in 16% (7/45) of the patients but one case, with severe thrombocytopenia, died of intracranial hemorrhage. Major hemorrhagic sequelae with even fatal events are possible, especially when a low platelet count is associated with other hemostatic abnormalities (e.g. haemophilia, liver disease, disseminated intravascular coagulation). Zidovudine therapy (range 500-1250 mg/day) is effective in normalizing the platelet count (platelets > 100,000/mmc) only in 29% (9/31) of the patients.
Subject(s)
HIV Infections/complications , HIV-1 , Thrombocytopenia/epidemiology , Adult , Fatal Outcome , Female , HIV Infections/epidemiology , HIV Infections/pathology , Humans , Italy/epidemiology , Male , Middle Aged , Prevalence , Thrombocytopenia/diagnosis , Thrombocytopenia/etiology , Thrombocytopenia/pathologySubject(s)
Acquired Immunodeficiency Syndrome/complications , Coccidiostats/therapeutic use , Cryptosporidiosis/drug therapy , Nitriles/therapeutic use , Opportunistic Infections/drug therapy , Triazines/therapeutic use , Cryptosporidiosis/complications , Humans , Opportunistic Infections/complicationsABSTRACT
The results of an epidemiological survey on surgical cases of human hydatidosis in 9 italian regions (Central, Southern and Insular Italy) with the highest incidence of disease and a population of 27,054,000 inhabitants are reported. The period considered was from 1980 through 1984. 2,592 cases have been collected and related to sex, age, occupation, residence of surgically treated patients and cyst localization. Comparison of results from the present and a previous survey was carried out.