ABSTRACT
PURPOSE: West Nile virus (WNV) transmission through organ transplantation occurs rarely and screening of organ donors for WNV infection remains controversial. This report describes the case of WNV encephalitis in a kidney recipient and the case of asymptomatic WNV infection in the organ donor, both observed at Treviso Hospital, northeastern Italy. After briefly reviewing the literature, we discuss the implications for WNV screening. METHODS: We reviewed medical, laboratory and epidemiological records at our hospital, and the literature concerning cases of organ-transmitted WNV infections and WNV screening of organ donors in Italy and worldwide. RESULTS: The kidney recipient was the first confirmed case of WNV infection notified in northeastern Italy in 2011, and the first case of WNV infection in a cluster of four transplant recipients who acquired the infection from a common organ donor. The organ donor, whose WNV infection was only retrospectively diagnosed by IgM detection, represents the index case of a WNV outbreak in the Treviso Province. Screening of her blood prior to organ recovery did not show detectable levels of WNV nucleic acid with the use of quantitative real-time polymerase chain reaction. CONCLUSIONS: This report emphasizes that transplant-acquired WNV neuroinvasive disease can be particularly severe. We suggest that pre-procurement screening of organ donors by testing blood with both WNV IgM capture ELISA and a sensitive nucleic acid testing should be adopted during the transmission season in the present Italian epidemiological setting.
Subject(s)
Tissue Donors , Transplantation , Transplants/adverse effects , West Nile Fever/transmission , West Nile virus/isolation & purification , Adult , Antibodies, Viral/blood , Coma/virology , Female , Humans , Italy , Male , RNA, Viral/blood , Transplants/virology , West Nile Fever/diagnosis , West Nile Fever/virologySubject(s)
Acetamides/adverse effects , Acetamides/therapeutic use , Acidosis, Lactic/chemically induced , Anti-Infective Agents/adverse effects , Discitis/drug therapy , Oxazolidinones/adverse effects , Oxazolidinones/therapeutic use , Tuberculosis/drug therapy , Acidosis, Lactic/therapy , Aged, 80 and over , Discitis/microbiology , Female , Humans , Linezolid , Lumbar Vertebrae/microbiology , Lumbar Vertebrae/pathology , Mycobacterium tuberculosis/isolation & purification , Treatment Outcome , Tuberculosis/microbiology , Tuberculosis/pathologyABSTRACT
We have assessed levofloxacin penetration in cerebrospinal fluid (CSF) and the liquor-to-plasma ratio (C(L)/C(P)) at 2 hours after dosing in 5 patients with spontaneous acute bacterial meningitis. CSF levofloxacin concentration at 2 hours after dosing was 1.99+/-0.67 microg/mL, and the C(L)/C(P) at 2 hours after dosing was 0.34+/-0.09.
Subject(s)
Anti-Infective Agents/cerebrospinal fluid , Levofloxacin , Meningitis, Escherichia coli/cerebrospinal fluid , Meningitis, Meningococcal/cerebrospinal fluid , Meningitis, Pneumococcal/cerebrospinal fluid , Ofloxacin/cerebrospinal fluid , Acute Disease , Adult , Aged , Anti-Infective Agents/pharmacokinetics , Anti-Infective Agents/therapeutic use , Female , Humans , Male , Meningitis, Escherichia coli/drug therapy , Meningitis, Meningococcal/drug therapy , Meningitis, Pneumococcal/drug therapy , Middle Aged , Ofloxacin/pharmacokinetics , Ofloxacin/therapeutic useSubject(s)
Anti-Infective Agents/therapeutic use , Levofloxacin , Meningitis, Bacterial/drug therapy , Ofloxacin/therapeutic use , Rhodococcus equi/isolation & purification , Ventriculoperitoneal Shunt/adverse effects , Actinomycetales Infections/drug therapy , Actinomycetales Infections/microbiology , Cross Infection/drug therapy , Cross Infection/microbiology , Female , Humans , Meningitis, Bacterial/microbiology , Middle Aged , Ventriculoperitoneal Shunt/instrumentationABSTRACT
Cytomegalovirus (CMV)-associated transverse myelitis is rare in immunocompetent patients. The case of a 54-year-old man is reported here who developed acute transverse myelitis with cerebrospinal fluid (CSF) alterations, suggesting a central nervous system infection. CMV-IgM positivity in serum and CMV isolated from blood, positive CMV PCR and positivity for pp65 antigen in blood, without viral antigens in the CSF and a positive response to therapy with ganciclovir (followed by progressive improvement) supported the diagnosis.
Subject(s)
Cytomegalovirus Infections/virology , Cytomegalovirus , Myelitis, Transverse/virology , Antibodies, Viral/blood , Antibodies, Viral/immunology , Antigens, Viral/immunology , Cytomegalovirus/immunology , Cytomegalovirus Infections/blood , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/immunology , Humans , Immunocompromised Host , Male , Middle Aged , Myelitis, Transverse/blood , Myelitis, Transverse/drug therapy , Myelitis, Transverse/immunology , Phosphoproteins/immunology , Viral Matrix Proteins/immunologyABSTRACT
We describe patient with Echinococcus granulosus disease primary localized on the back. This case is uncommon because of the lack of risk exposure history and the sole muscular localization. The patient received several surgical operations on the back, without eradication of the infestation. At the end we discuss the clinical considerations that induced the choice of the usual medical therapy
