ABSTRACT
This study evaluated the efficacy, safety and durability of a switch to co-formulated RPV/TDF-TAF/FTC (RPV-STR) or DTG/ABC/3TC (DTG-STR) in virologically-suppressed HIV-positive patients in a single Italian centre. All HIV-infected ART-experienced patients switching to RPV-STR or DTG-STR with HIV-RNA <50 copies/mL were included. Outcomes were incidence rate and rate ratios for discontinuation due to all causes (DAC), to adverse events (DAE) and to virological failure (VF) after 4 years of follow-up. We included 402 patients (244 on RPV-STR, 158 on DTG-STR). At Year 4 of follow-up, 124 patients (30.8%) discontinued for any cause (71 on RPV-STR, 53 on DTG-STR). Fifteen patients experienced VF [13 (5.3%) on RPV-STR and 2 (1.3%) on DTG-STR; log-rank, P = 0.4413]. Overall, 46 patients (11.4%) had AEs (23 on RPV-STR, 23 on DTG-STR). Nausea/diarrhoea was more frequent with DTG-STR (4.4% vs. 0%) and neurological toxicity with RPV-STR (4.5% vs. 2.5%). The rate of DAC within the first 3 months was significantly higher with DTG-STR (aRR = 5.88, 95% CI 3.20-10.81; P < 0.001); similarly, the discontinuation rate due to AEs was significantly higher with DTG-STR compared with RPV-STR (aRR = 12.89, 95% CI 5.48-30.32; P < 0.001). No difference in VF was observed between the two groups (RR = 0.47, 95% CI 0.10-2.14; P = 0.335). Patients with undetectable viral load who switched to DTG-STR or RPV-STR maintained virological suppression with a low risk of VF. A higher discontinuation rate was observed with DTG-STR compared with RPV-STR, particularly within 3 months from switch.
Subject(s)
Anti-HIV Agents/therapeutic use , Drug Combinations , Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination/therapeutic use , HIV Infections/drug therapy , Heterocyclic Compounds, 3-Ring/therapeutic use , Lamivudine/therapeutic use , Rilpivirine/therapeutic use , Adult , Cohort Studies , Female , HIV-1 , Humans , Immunocompromised Host , Italy , Male , Middle Aged , Treatment OutcomeABSTRACT
The sternal localization of bone and joint tuberculosis (TB) is rare, has an insidious clinical presentation, and usually affects young adults living in endemic areas. Mycobacterium africanum causes a relevant proportion of human TB in West Africa and in migrants from endemic countries. Here, we report two cases of sternal osteomyelitis due to M. africanum in migrants.
Subject(s)
Mycobacterium/classification , Mycobacterium/isolation & purification , Osteomyelitis/etiology , Osteomyelitis/pathology , Sternum/pathology , Tuberculosis/diagnosis , Tuberculosis/pathology , Adult , Africa , Humans , Male , Osteomyelitis/diagnostic imaging , Osteomyelitis/microbiology , Radiography, Thoracic , Sternum/diagnostic imaging , Tomography, X-Ray Computed , Tuberculosis/diagnostic imaging , Tuberculosis/microbiology , Young AdultABSTRACT
This report focuses on epidemiological and clinical features of dengue fever (DF) in Tuscany (Italy) between 2006 and 2012. Sixty-one DF cases were diagnosed, 32 of which were in the period of Aedes albopictus activity. Some clinical (arthralgia/myalgia, nausea/vomiting, and skin rash), laboratory (leukopenia and thrombocytopenia), and epidemiological characteristics (travel in a continent other than Africa) significantly distinguished DF cases from other febrile illnesses. Our data stress the importance of increasing awareness on dengue in Italy among clinicians in order to reach an early diagnosis in returning travelers and to implement appropriate clinical and public health interventions.
Subject(s)
Dengue/epidemiology , Dengue/prevention & control , Travel , Adult , Aged , Animals , Communicable Disease Control , Culicidae , Disease Vectors , Female , Humans , Italy/epidemiology , Male , Middle Aged , Tropical ClimateABSTRACT
We present the case of two Australian tourists aged 25 and 26 years who, after immersion in a canal in Venice, developed severe leptospirosis. After a 1-week history of fever, headache, myalgia, and vomiting they developed jaundice and renal failure. Complete remission was achieved by antibiotic therapy and hemodialysis.
Subject(s)
Ceftriaxone/administration & dosage , Leptospira/isolation & purification , Leptospirosis , Acute Kidney Injury/etiology , Administration, Intravenous , Adult , Anti-Bacterial Agents/administration & dosage , DNA, Bacterial , Disease Reservoirs/microbiology , Fresh Water/microbiology , Humans , Italy/epidemiology , Leptospirosis/complications , Leptospirosis/diagnosis , Leptospirosis/drug therapy , Leptospirosis/epidemiology , Leptospirosis/physiopathology , Liver Diseases/etiology , Male , Polymerase Chain Reaction/methods , Symptom Assessment/methods , Treatment Outcome , Urine/microbiologyABSTRACT
We present a case of a 60-year-old Caucasian woman carrying a 2-year-old hip prosthesis infected by Candida glabrata dose-dependent susceptible to fluconazole and voriconazole. Resection arthroplasty was performed. Six weeks of caspofungin plus liposomal amphotericin combination therapy achieved joint sterilization and allowed a successfully reimplantation arthroplasty. In addition we review 9 cases of C. glabrata prosthetic joint infection described to date in the literature.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Candida glabrata/isolation & purification , Candidiasis/etiology , Prosthesis-Related Infections/microbiology , Antifungal Agents/therapeutic use , Candidiasis/microbiology , Candidiasis/therapy , Device Removal , Female , Hip Prosthesis/microbiology , Humans , Middle Aged , Prosthesis-Related Infections/etiology , Prosthesis-Related Infections/therapy , ReoperationABSTRACT
The volatile oil of the bark of Cinnamomum zeylanicum was extracted by means of supercritical CO2 fluid extraction in different conditions of pressure and temperature. Its chemical composition was characterized by GC-MS analysis. Nineteen compounds, which in the supercritical extract represented >95% of the oil, were identified. (E)-Cinnamaldehyde (77.1%), (E)-beta-caryophyllene (6.0%), alpha-terpineol (4.4%), and eugenol (3.0%) were found to be the major constituents. The SFE oil of cinnamon was screened for its biological activity about the formation of melanin in vitro. The extract showed antityrosinase activity and was able to reduce the formation of insoluble flakes of melanin from tyrosine. The oil also delayed the browning effect in apple homogenate. (E)-Cinnamaldehyde and eugenol were found to be mainly responsible of this inhibition effect.
