Presence of Legionella spp. in human dental plaque.

AIMS: The aim of this research is to verify the presence of Legionella in human dental plaque. METHODS: 65 adult patients not treated with systemic or local antibiotics at least 2 months before the time of sample collection were enrolled for plaque collection between September 2015 and December 2016. A brief questionnaire about lifestyle and health risks was administered. Legionella spp. detection has been executed by semi- nested PCR. RESULTS: 8 out of 65 plaque samples (12.3%) were positive for Legionella spp. As regards health risks and lifestyle aspects, no relevant difference was observed between patients involved in our study, except for two positive patients who have reported a COPD ongoing and a pneumonia in the past. CONCLUSIONS: This study represents a step forward in the knowledge of reservoirs of the microorganism and richness of oral microbiota.

Prevention of fecal-orally transmitted diseases in travelers through an oral anticholeric vaccine (WC/rBS).

INTRODUCTION: Estimate the efficacy of oral anticholeric vaccine Dukoral in subjects travelling to high-risk areas for traveler's diarrhoea and cholera. METHODS: The study involved subjects of both genders who planned to travel to high-risk areas for traveler's diarrhoea and cholera. Immunization with oral anticholeric vaccine Dukoral was offered to each one of them. Upon returning, all the participants in the study were asked to complete a self-administered questionnaire consisting of 40 close-ended questions mainly concerning: personal and health data, characteristics (length, destination, reason) of the travel, onset of gastrointestinal symptoms, data relating to the assumption of anticholeric vaccine and possible adverse reactions. RESULTS: 296 questionnaires have been collected. Mean age was 38.2 years (55.4% males and 44.6% females). Mean travel length was 22.2 days. Reasons for the travel: 66.8% tourism and 33.2% work-cooperation. Most frequent destination was Africa (48.1%), followed by Asia (32.1%) and central South-America (17.8%). 199 subjects (67.2%) properly executed vaccination with Dukoral. The diarrhoea affected 14.1% of vaccinated subjects and 20.6% of non vaccinated ones. The following cohorts showed statistically significant differences in incidence of diarrhoea: <35 years old age (13.7% vs. 27.1%), travel for work-cooperation (14.1% vs. 35%) and travel length >28 days (12.1% vs. 40%). No serious adverse events were reported following vaccination. DISCUSSION: Oral Anticholeric vaccine proved to be effective and safe in preventing fecal-oral diseases in travelers exposed to high risk conditions.

Aetiology and prognosis of bacteraemia in Italy.

A prospective multi-centre study was conducted to assess the microbiological pattern and prognostic factors of bacteraemia and their impact on clinical outcome. All patients admitted to 41 Italian hospitals over 2 months, from whom one or more clinically significant organisms were isolated from blood culture, were studied according to a standardized protocol and case definition. A total of 156 episodes of bacteraemia were identified in 20,601 patients. There were 3.9 episodes of nosocomially acquired bacteraemia and 3.7 episodes of community-acquired bacteraemia per 1000 admissions. The most frequent pathogens isolated were Gram-negative bacteria (44.9%) but Gram-positive species accounted for 40.4 % of episodes. Fungal infections due to Candida spp. were found in 3.8 % of episodes, and multiple pathogens were recovered from 9.6% of episodes. The clinical response to bacteraemia was classified as sepsis in 90 episodes (577%), severe sepsis in 21 (13.5%) and septic shock in 26 (167%); 19 episodes (12.2%) showed no clinical response. The total in-hospital mortality was 25.0%. By multivariate logistic regression, the variables which independently predicted mortality were increasing age, the presence of septic shock, infection with Gram-positive bacteria or fungi and nosocomial acquisition.

Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000.

A one-day survey was carried out in 88 out of 113 public hospitals in Lombardy to obtain prevalence rates of hospital-acquired infections (HAIs) by hospital departments and to identify the pathogens more frequently involved. In total 18667 patients were surveyed, representing 72% of the average daily total of occupied beds in public hospitals in Lombardy. The overall prevalence of HAI was 4.9%. The highest prevalence was observed in intensive care units and in spinal units. The prevalence of bloodstream infections was 0.6%; pneumonia 1.1%; urinary tract infections 1.6% and gastrointestinal infections 0.4%. In surgical patients the prevalence of surgical site infections was 2.7%. The most frequently isolated pathogen from all sites of infections was Escherichia coli (16.8%), followed by Staphylococcus aureus (15.0%), Pseudomonas aeruginosa (13.2%) and Candida spp. (8.7%). Methicillin-resistant S. aureus accounted for 23% of all isolated S. aureus. The results provide baseline data for rational priorities in allocation of resources, for further studies and for infection control activities.

Tuberculosis among immigrants from developing countries in the province of Milan, 1993-1996.

SETTING: The Province of Milan, which has high rates of immigration from developing countries, and the Villa Marelli Institute (VMI), Reference Centre for Tuberculosis Control of Lombardy. OBJECTIVE: To describe epidemiology and clinical patterns of tuberculosis among immigrants from developing countries (IDCs) in the Province from 1993 to 1996. DESIGN: Retrospective analysis of the registries of the Regional Bureau for Public Health and of the VMI concerning immigrant patients with active TB living in the Province. Restriction fragment length polymorphism (RFLP) analysis of the available strains to detect recent transmission among immigrants. RESULTS: IDCs represented 22.8% of all TB cases. The standardised incidence rate was eight times higher in IDCs compared to Italians. Of 596 cases notified in IDCs, 524 (87.9%) had been referred at least once to the VMI. Of these, 77.2% were diagnosed within 5 years of arrival, and 86.6% were brought to medical attention because of symptoms. RFLP fingerprinting demonstrated that the mean period of stay in Italy was significantly higher in clustered than in non clustered patients (61.5 versus 37.3 months). Spread to the native population was episodic. CONCLUSIONS: The incidence of TB is higher among more recent immigrants (i.e., Peruvians). TB cases are largely due to reactivation of infection occurring in the country of origin. Preventive measures for early diagnosis of disease or chemoprophylaxis of dormant infection are not regularly performed, but should be implemented for those immigrants at high risk.

Behaviour of different clinical, immunological and serological parameters observed in a group of HIV positive patients during a 12 month treatment period with zidovudine.

During a 12 month open clinical trial, 14 patients (6 with AIDS, 2 with ARC and 6 with PGL) were continuously administered a daily 1200 mg dose of Zidovudine. Clinical course was correlated with a number of serological (HIV p24 antigen, p17 and p24 antibodies) and immunological (CD4 cell counts, serum neopterin and beta 2-microglobulin levels) parameters. All patients survived until the end of the trial: none developed major opportunistic infections, but 5 required an average of 7 blood transfusions each. Disappearance of p24 Ag was observed in 4 out of 7 patients, although with a subsequent reappearance in 3; moreover, changes of p24 Ag and HIV core Ab profiles were generally paralleled by neopterin and, to a lesser extent, by CD4/neopterin ratio variations. In the long run, significant differences between baseline and end-point results were shown by neopterin, but not by CD4 cell counts and beta 2-microglobulin levels. Efficacy of Zidovudine therapy seemed to be mainly related to clinical, but even more so, to immunological and serological status at baseline; in fact, severe clinical deterioration was observed in 2 patients who had an already low CD4/neopterin ratio from the beginning, coupled with a p24 Ag positivity and a negativity of both anti-p17 and -p24. Conversely, a stable clinical condition was observed in those patients in whom the reverse was true.

CD4+:neopterin ratio correlates with p24 antigenaemia in HIV infected patients.

In an effort to improve the Walter Reed Staging System (WR), which mainly relies on immune depletion parameters, by introducing viral replication and T-cell activation markers, we examined by p24 antigenaemia and serum neopterin levels (SNL) 72 HIV positive PGL, ARC and AIDS patients (11 of whom classified as WR 2, 21 as WR 3, 16 as WR 5 and 24 as WR 6). While CD4 cell counts, already weakly correlating with the WR itself, did not significantly differ between p24 antigen (p24 AG) positive and negative patients, striking differences between the two groups, especially in PGL patients (p less than 0.0001), were found as far as SNL was concerned. In fact, SNL values, fluctuating around 10 and 30 nmol/l, respectively, in p24 Ag positive and negative patients regardless of their WR allocation, seemed rather to reflect, as global means of any given class, prevalence rate of p24 Ag positivity. We suggest, therefore, to use CD4/SNL ratio (R) for HIV infection and disease staging, as it not only may represent a compromise index between cellular immune depletion and T-cell activation, but also seems to take into account the viral replication component, already shown to be an important predictive marker of disease progression.