The impact of rifaximin in the prevention of bacterial infections in cirrhosis.

OBJECTIVE: Bacterial infections are a leading factor in the progression from compensated to decompensated cirrhosis, with consequent worsening of the prognosis, and concerted efforts have been made to reduce infections and improve the survival rate of these patients. We retrospectively investigated the rate of infections in hospitalized cirrhotic patients under treatment with rifaximin. PATIENTS AND METHODS: We enrolled 649 patients whose clinical and personal data, prescribed therapy, microbiological findings and laboratory tests were collected from previous discharge letters and our institution database. The efficacy of rifaximin in preventing several types infection was evaluated by comparing outcomes for rifaximin-treated patients vs patients receiving no antibiotic treatment. RESULTS: The risk of developing selected bacterial infections was significantly lower in patients treated with rifaximin (OR 0.29; 95% CI 0.20-0.40, p < 0.001). CONCLUSIONS: Continuous treatment with rifaximin may prevent bacterial infections in cirrhotic patients.

Prevalence and histologic features of transfusion transmitted virus and hepatitis C virus coinfection in a group of HIV patients.

BACKGROUND: A recently identified DNA transfusion-transmitted virus has been associated with post-transfusion non-A to G hepatitis. AIM: To determine the prevalence of transfusion-transmitted virus in patients with human immunodeficiency virus infection. Its clinical role in the pathogenesis of liver disease was also evaluated in patients with transfusion-transmitted-virus hepatitis C virus coinfection compared with those with hepatitis C Virus infection alone. PATIENTS AND METHODS: We evaluated 312 HIV-hepatitis C virus coinfected patients (225 males, 87 females). All underwent screening for transfusion-transmitted virus DNA using a nested polymerase chain reaction technique. In some transfusion transmitted virus-DNA positive patients, we performed a phylogenetic analysis. In 56 patients (20 transfusion-transmitted-virus-hepatitis C virus and 36 hepatitis C virus alone), liver biopsy was collected. RESULTS: The prevalence of transfusion-transmitted virus was 113/312 (36%). The genotype distribution was similar to that reported in other studies. No difference in liver histology was found between the two groups. CONCLUSION: Transfusion-transmitted virus infection is common in human immunodeficiency virus patients. We found no histologic differences between liver biopsy specimens from patients coinfected with transfusion-transmitted virus plus hepatitis C virus compared with those infected with hepatitis C virus alone. Transfusion-transmitted virus is not clearly associated with a distinct liver injury.

Quantification of HIV-1 proviral DNA in patients with undetectable plasma viremia over long-term highly active antiretroviral therapy.

OBJECTIVES: To assess the prognostic role of proviral DNA in peripheral blood mononuclear cells (PBMC) of patients with undetectable viremia over long-term highly active antiretroviral therapy (HAART). METHODS: Eighty-two human immunodeficiency virus (HIV)-1-infected patients, free of acquired immunodeficiency syndrome (AIDS), received zidovudine plus lamivudine plus indinavir. Levels of plasma HIV-RNA, and PBMC proviral DNA and RNA unspliced (US) transcripts were evaluated by using competitive polymerase chain reaction (cPCR) assays, every 3 months over 1 year. RESULTS: Among patients with undetectable viremia at baseline, 13 of 18 with CD4 cell count 350/mm3 or less and 12 of 16 with CD4 between 351 and 700/mm3, constantly maintained undetectable RNA levels; in these patients, a mean proviral DNA decrease of 0.67 6 0.7 and 1.03 6 0.53 log (P < 0.001), respectively, a significant decrease of RNA-US transcripts (P < 0.001), and significant correlations between decreases of proviral DNA and RNA-US transcripts (P = 0.008 and P < 0.001, respectively) were observed. CONCLUSIONS: Proviral DNA quantitation permits the continued monitoring of HAART in patients with undetectable viremia.

Efficacy of a short-term amphotericin B + flucytosine combination therapy followed by itraconazole monotherapy in acute and chronic AIDS-associated cryptococcosis.

The authors report the clinical and microbiological findings of a 6-month follow-up of nine AIDS patients affected with cryptococcosis. Among these, seven patients suffered from meningoencephalitis and two from disseminated infection. The antifungal therapy during acute illness included the administration of amphotericin B at doses of 0.6 mg kg-1 day-1 i.v. plus flucytosine at doses of 100 mg kg-1 day-1 i.v. during the first 15 days followed by itraconazole at doses of 400 mg day-1 p.o. in the following 15 days. The maintenance treatment included itraconazole at doses of 200 mg day-1 p.o. indefinitely. During the 6-month follow-up, one patient died of hepatic failure related to C virus (HCV) hepatitis reactivation and another patient died of polymicrobial pneumonia. In two patients, the presence of multiple nodular lesions in the cerebral computerized tomography (CT) scan, related to cryptococcal granulomas, was associated with the persistance of fungi in the cerebrospinal fluid. In three patients with meningoencephalitis the three-drugs regimen was effective in eradicating the neurological infection, and relapses were not observed during the maintenance therapy with itraconazole during the 6-month follow-up. The two patients with haematogenous cryptococcosis did not relapse after the 6-month follow-up.

Value of culture of pus via percutaneous drainage under sonographic guidance in diagnosis and therapy of pyogenic liver abscess.

Pyogenic hepatic abscess is often a serious disease, whose rates of cure are proportional to the timeliness of treatment and the correct use of antibiotics. The final choice of antibiotics should be guided by the results of a culture. Local cultures of pus are more often positive than blood cultures It is essential to plan an effective treatment regimen when dealing with immunocompromised patients. Our results, regarding 85 patients with pyogenic liver abscess, 19 of which were immunocompromised, seen at our Department from 1980 to 1992, indicate that planning the therapy on the base of blood culture alone means a 78% risk of inappropriate treatment.

Ultrasound in the diagnosis of gallbladder ascariasis.

Ascariasis is the most common helminthic infection, but the invasion of worms into the gallbladder is quite rare. This report illustrates the ultrasonographic findings in gallbladder ascariasis of a typical echogenic structure which exhibits nondirectional movements and contains a central anechoic tube, along the long axis of the gallbladder. The role of ultrasound as a diagnostic tool and in the follow-up treatment is stressed.

HIV-related Hodgkin's disease. Report of nine cases.

BACKGROUND: The association between lymphoproliferative disease and AIDS is now well known, but only non-Hodgkin's lymphomas (LNH) are surely related to HIV infection. Hodgkin's disease (HD) occurs rarely in HIV seropositives, so it is impossible to establish a connection between AIDS and this neoplasm. METHODS AND RESULT: We describe nine cases of HIV seropositive patients who developed HD in different stages of the HIV infection. We carefully examine clinical course and response to therapy in these patients, above all paying attention to opportunistic infections (OI) and progression to full-blown AIDS. CONCLUSION: Finally, we discuss the possibility of including HD among the definition criteria for AIDS.