[Actuality of Giuseppe D'Alessandro's contribution to the knowledge of the antigenic structure of Treponema pallidum when syphilis is re-emerging as a public health problem]. / Attualità del contributo di Giuseppe D'Alessandro alla conoscenza della struttura antigenica del Treponema pallidum al riemergere della sifilide come problema di sanità pubblica.

The antigenic structure of Treponema pallidum was described in the 1940s and 1950s. The main contributions of Giuseppe D'Alessandro and his collaborators included the description of the external membrane and of the polysaccharide antigen found in the cell wall of the microorganism. Based on new knowledge it has been possible to develop diagnostic tests that are more sensitive and specific than nontreponemal tests, which nevertheless retain their validity in the current re-emergence of syphilis as a public health problem.

Parents' attitudes and behaviours towards recommended vaccinations in Sicily, Italy.

BACKGROUND: Since a long time, Italy has maintained a dual system to administer childhood immunisations, that is a certain number of mandatory vaccinations and a number of recommended vaccinations. The study aimed to explore the issues surrounding parental acceptance or non-acceptance of the recommended vaccinations for children. METHODS: Parents of children aged 3-5 years of day-care centres in Sicily were asked to fill out an anonymous questionnaire. Determinants of the attitude towards recommended vaccinations and social influence on the decision-making process were assessed using logistic regression analysis. RESULTS: Of the 1,500 selected parents, 81.0% participated in the study. Prior to the survey, the majority of children (97.6%) received recommended vaccines. Most parents (74.4%) received information about vaccinations from Family Paediatricians, showed a good knowledge about the side effects of the vaccines (73.1%), did not worry about their potential dangerousness (53.0%) and would have accepted their children to be vaccinated even if it was not required for day care (84.1%). The majority (79.9%) were not disposed to follow the advises of the anti-vaccination movements. Parents' background characteristics, sources of information and social influence were not significantly associated with parental acceptance of recommended vaccines for childhood. CONCLUSIONS: This study suggests that health information by Family Paediatricians is significantly associated with parental acceptance of recommended vaccinations.

Phylogenetic analysis of the genera Proteus, Morganella and Providencia by comparison of rpoB gene sequences of type and clinical strains suggests the reclassification of Proteus myxofaciens in a new genus, Cosenzaea gen. nov., as Cosenzaea myxofaciens comb. nov.

Phylogenetic analysis of partial rpoB gene sequences of type and clinical strains belonging to different 16S rRNA gene-fingerprinting ribogroups within 11 species of enterobacteria of the genera Proteus, Morganella and Providencia was performed and allowed the definition of rpoB clades, supported by high bootstrap values and confirmed by ≥2.5 % nucleotide divergence. None of the resulting clades included strains belonging to different species and the majority of the species were confirmed as discrete and homogeneous. However, more than one distinct rpoB clade could be defined among strains belonging to the species Proteus vulgaris (two clades), Providencia alcalifaciens (two clades) and Providencia rettgeri (three clades), suggesting that some strains represent novel species according to the genotypes outlined by rpoB gene sequence analysis. Percentage differences between the rpoB gene sequence of the type strain of Proteus myxofaciens and other members of the same genus (17.3-18.9 %) were similar to those calculated amongst strains of the genus Providencia (16.4-18.7 %), suggesting a genetic distance at the genus-level between Proteus myxofaciens and the rest of the Proteus-Providencia group. Proteus myxofaciens therefore represents a member of a new genus, for which the name Cosenzaea gen. nov., is proposed.

Molecular epidemiology of ampicillin resistance in Salmonella spp. and Escherichia coli from wastewater and clinical specimens.

Molecular epidemiology at local scale in Sicily (Italy) of ampicillin resistance in Salmonella spp. isolates from municipal wastewater (n = 64) and clinical specimens (n = 274) is described in comparison with previously examined Escherichia coli isolates (n = 273) from wastewater. High prevalence of antibiotic resistance (28.9%) with highest resistance rates against ampicillin (22.7%) was observed in E. coli isolates. Different resistance rates were observed in Salmonella according to the serovars, with prevalences of the same order in both wastewater and clinical isolates belonging to the same serovar (e.g., 91.7% ampicillin resistance in wastewater isolates vs. 70.8% in clinical isolates of the Salmonella serovar Typhimurium and 0% ampicillin resistance in both wastewater and clinical isolates of the Salmonella serovar Enteritidis). The beta-lactam resistance gene bla(TEM) was present in both wastewater and clinical Salmonella spp. isolates, with the exception of Salmonella enterica serovar Typhimurium isolates with a typical six-drug resistance pattern AmpChlSulTeStrSp that had the bla(PSE-1) gene. The bla(TEM) gene was present in all the E. coli isolates but one had the bla(SHV) gene. Several E. coli and some Salmonella isolates were positive for class 1 integrons with variable regions of 1.0 or 1.5 kb containing aadA1, dfrA17-aadA5, or dfrA1-aadA1 gene cassettes, whereas Salmonella serovar Typhimurium isolates with the six-drug resistance pattern were positive for both 1.0 and 1.2 kb integrons. Polymerase chain reaction replicon typing demonstrated the presence of multireplicon resistance plasmids in several isolates of E. coli, containing two to four of the replicons IncF, IncI1, IncFIA, and IncFIB, whereas other isolates showed resistance plasmids with only IncF, IncP, or IncK replicons. Replicon IncI1 was detected in one Salmonella isolate, whereas other isolates belonging to different serovars had IncN replicons. Analysis of isolates from wastewater can be a useful epidemiologic tool to monitor the prevalence of antibiotic resistance and genetic elements related to antibiotic resistance in Salmonella clones circulating in the human population.

An economic analysis of rotavirus vaccination in Italy.

We have evaluated health and economic benefits of a universal infant vaccination with two rotavirus vaccines registered in Italy, on the bases of the burden of rotavirus gastroenteritis (RVGE) in a birth cohort of 520,000 Italian infants followed until 5 years of age. Estimates from published and unpublished sources of disease burden, costs, vaccine coverage, efficacy trials of both vaccines, and price were used to estimate cost-effectiveness from the perspectives of the Italian National Health Service (NHS) and society. According to our estimates, a universal rotavirus vaccination program would avoid 10,679 hospitalizations, 39,202 emergency visits, and 44,223 at home visits. At 65.6 euro per vaccination courses, the program would cost 30,700,800 euro and realize a net loss of 9,057,928 euro from the Italian NHS perspective. On the contrary, the program would provide a net savings of 24,324,198 euro from the societal perspective. From the Italian NHS perspective, the break-even price per vaccination course should be reduced at least to 46.25 euro to achieve a zero cost-effectiveness ratio.

[Excessive Internet use and Internet addiction: emerging public health issues.]. / Abuso e dipendenza da Internet come problemi emergenti di sanità pubblica.

A survey was performed among students of various faculties at the University of Catania (Italy) to examine the health effects of excessive Internet use and behaviour patterns of Internet dependency. Three hundred students were recruited through a non probabilistic quota sampling method and were asked to complete a questionnaire aimed at identifying attitudes and behaviours regarding Internet use, and the psychological and physical consequences of excessive use of the Internet. The most relevant findings that emerged from student responses regard: emotional dependency on the Internet (5% of students believe that Internet facilitates social relationships, 4% experiences euphoric feelings or excitement while on-line, 1% consider the Internet as a way of escaping from real life), the excessive amount of time spent on-line (8%) and the inability to end an on-line session(8%), lying to family members to conceal the nature of involvement with the Internet (3%), giving up sports (2%) or meals (1%), the negative impact on school grades (3%), lack of sleep (4%), and physical health problems such as backache (2%), arm or wrist pain (2%), vision disturbances (6%).

Interstitial pulmonary inflammation due to Microbacterium sp. after heart transplantation.

A coryneform bacterium was isolated from the bronchoalveolar aspirate of a patient with interstitial pulmonary inflammation. Commercial systems identified the isolate as Corynebacterium sp. or Aureobacterium sp./Corynebacterium aquaticum, but 16S rRNA gene analysis unequivocally attributed it to the genus Microbacterium. This represents the first documented case of Microbacterium pulmonary infection.

Value of morphotyping for the characterization of Candida albicans clinical isolates.

Until recently, morphotyping, a method evaluating fringe and surface characteristics of streak colonies grown on malt agar, has been recommended as a simple and unexpensive typing method for Candida albicans isolates. The discriminatory power and reproducibility of Hunter's modified scheme of Phongpaichit's morphotyping has been evaluated on 28 C. albicans isolates recovered from the oral cavity of asymptomatic human immunodeficiency virus-positive subjects, and compared to two molecular typing methods: randomly amplified polymorphic DNA (RAPD) fingerprinting, and contour clamped homogeneous electric field (CHEF) electrophoretic karyotyping. Morphological features of streak colonies allowed to distinguish 11 different morphotypes while RAPD fingerprinting yielded 25 different patterns and CHEF electrophoresis recognized 9 karyotypes. The discriminatory power calculated with the formula of Hunter and Gaston was 0.780 for morphotyping, 0.984 for RAPD fingerprinting, and 0.630 for karyotyping. Reproducibility was tested using 43 serial isolates from 15 subjects (2 to 6 isolates per subject) and by repeating the test after one year storage of the isolates. While genetic methods generally recognized a single type for all serial isolates from each of the subjects studied, morphotyping detected strain variations in five subjects in the absence of genetic confirmation. Poor reproducibility was demonstrated repeating morphotyping after one year storage of the isolates since differences in at least one character were detected in 92.9% of the strains.

Value of morphotyping for the characterization of Candida albicans clinical isolates

Until recently, morphotyping, a method evaluating fringe and surface characteristics of streak colonies grown on malt agar, has been recommended as a simple and unexpensive typing method for Candida albicans isolates. The discriminatory power and reproducibility of Hunter's modified scheme of Phongpaichit's morphotyping has been evaluated on 28 C. albicans isolates recovered from the oral cavity of asymptomatic human immunodeficiency virus-positive subjects, and compared to two molecular typing methods: randomly amplified polymorphic DNA (RAPD) fingerprinting, and contour clamped homogeneous electric field (CHEF) electrophoretic karyotyping. Morphological features of streak colonies allowed to distinguish 11 different morphotypes while RAPD fingerprinting yielded 25 different patterns and CHEF electrophoresis recognized 9 karyotypes. The discriminatory power calculated with the formula of Hunter and Gaston was 0.780 for morphotyping, 0.984 for RAPD fingerprinting, and 0.630 for karyotyping. Reproducibility was tested using 43 serial isolates from 15 subjects (2 to 6 isolates per subject) and by repeating the test after one year storage of the isolates. While genetic methods generally recognized a single type for all serial isolates from each of the subjects studied, morphotyping detected strain variations in five subjects in the absence of genetic confirmation. Poor reproducibility was demonstrated repeating morphotyping after one year storage of the isolates since differences in at least one character were detected in 92.9 percent of the strains.

[Attitudes and risk-taking behaviour for HIV infection, of drug addicts followed by a Drug Addiction Treatment Service (Ser.T).]. / Atteggiamenti e comportamenti a rischio di infezione da HIV in tossicodipendenti in trattamento presso il Ser.T.

A questionnaire was administered to 160 injection drug users, enrolled in a methadone or buprenorphine maintenance treatment program at their local Drug Addiction Treatment Service (Ser.T), in order to measure their attitudes and risk-taking behaviours towards HIV. Despite being on a maintenance treatment program, almost half of the interviewed subjects (43,75%) declared that they continued to use drugs, occasionally (15,62%), monthly (6,25%), weekly (10,62%) or daily (11,25%). Moreover, a high rate of risk-taking behaviour for HIV was found among the interviewed drug addicts, such as sharing of injection equipment (39,40%), irregular condom use (15,00%) and unprotected sex with casual partners (9,40%). When asked about which interventions they would consider to be most effective for HIV prevention, more than half of the interviewed subjects (58,12%) indicated qualified information regarding HIV transmission, while a lower but not negligible proportion of subjects thought the free distribution of syringes (21,25%) or condoms (20,63%) would be most effective. In contrast to other studies, our results show that pharmacological maintenance treatments may not have a role in preventing HIV infection among injection drug users. On the other hand, our results suggest that the presence, within the Ser.T team, of professional educators specialized in the prevention of sexually transmitted diseases may be more useful.

Molecular typing of Agrobacterium species isolates from catheter-related bloodstream infections.

Agrobacterium isolates from intravenous catheters of three hospitalized patients were initially identified as A. tumefaciens, but inability to produce 3-ketolactose revealed that two of them were A. vitis. However, rDNA analysis correlated all of the isolates to A. tumefaciens. Pulsed-field gel electrophoresis analysis ascertained the nosocomial transmission of the infection.

[Behavioural risks in food-related disorders: a teen-age sample from senior high schools in Catania, Sicily]. / Atteggiamenti e comportamenti a rischio per i disturbi dell'alimentazione in un campione di adolescenti delle scuole medie superiori di Catania.

The authors have carried out a survey on teen-age girls (398 girls aged 15-18) from five different senior high schools in Catania, Sicily. Students were submitted a questionnaire aimed at detecting behaviours at risk as regards food-related disorders. The most significant data concerned low body weight (20.4% having a Body Mass Index < 18.5), drug intake to lose weight (2.5%), self-induced vomit or intention to do so (12.1%), as well as a sort of uneasiness to attend other schoolmates due to one's own body weight (9.6%). These variables might reflect risk indicators as regards food-related disorders.

Characterization of Shiga toxin-producing Escherichia coli O157:H7 isolated in Italy and in France.

Twenty-one Escherichia coli O157:H7 strains isolated in northern Italy from sporadic cases of hemolytic-uremic syndrome and from cattle and food were characterized by virulence gene analysis, pulsed-field gel electrophoresis (PFGE) of XbaI-digested DNA, enterobacterial repetitive intergenic consensus (ERIC) sequence-based PCR (ERIC-PCR), and antibiotic resistance patterns and compared to 18 strains isolated in France from human cases of diarrhea, cattle, and the environment. Strains isolated in Sicily (southern Italy) from a local farm (one strain) and from calves just imported from France (11 strains) and Spain (six strains) were also typed. Whereas the eae and hlyA genes were always detected, Shiga toxin gene (stx) analysis showed some differences related to geographic areas. Isolates from northern Italy showed a high frequency of stx(1) and stx(2), while strains isolated in France and from French and Spanish calves imported to Sicily more frequently possessed the stx(2c) gene. The majority of the strains isolated in northern Italy were also resistant to one or more antibiotics, while most of the strains isolated in France and Sicily were fully susceptible. ERIC-PCR analysis was not able to differentiate the strains. PFGE typing after XbaI DNA digestion produced a total of 54 distinct restriction endonuclease digestion profiles (REDPs) among the 57 strains. Phylogenetic analysis was unable to cluster REDPs according to geographic origin. All epidemiologically related isolates showed either identical or >/=91% similar REDPs. Our findings suggest a peculiar circulation of antibiotic-resistant, genetically unrelated strains in northern Italy.

Persistent endemicity of Salmonella bongori 48:z(35):--in Southern Italy: molecular characterization of human, animal, and environmental isolates.

From 1984 to 1999, we collected 31 isolates of the rare serovar Salmonella bongori 48:z(35):- in southern Italy. Twenty-four of the isolates were from cases of acute enteritis in humans. Pulsed-field gel electrophoresis analysis showed that all but one of our isolates were at least 80% similar. Our findings suggest that genetically related S. bongori 48:z(35):- strains are endemically circulating in southern Italy.

[The importance of monitoring legionellosis in hospital setting: the case of a Sicilian Hospital]. / Considerazioni circa l'utilità del monitoraggio della presenza di legionelle in ambiente ospedaliero: una esperienza presso un ospedale siciliano.

Hospital-acquired legionellosis is a major problem. In Italy this issue is still underestimated because the reported figures are lower than the actual cases. This is probably due to a lack of diagnosis and monitoring. In Sicily, no cases of hospital-acquired legionellosis were reported in the last few years. In the year 2001, a reference laboratory was set up to help health authorities monitor and prevent hospital-acquired legionellosis. The authors report the data concerning a measure of environmental monitoring and water treatment carried out in a hospital where no legionellosis was ever detected before.

[Behavioural attitude of the young as regards road accident prevention: a survey carried out among high school students in two Sicilian towns]. / Atteggiamenti e comportamenti dei giovani nei riguardi della prevenzione degli incidenti stradali: una indagine tra gli studenti delle scuole medie superiori in due diversi contesti urbani siciliani.

This survey is aimed at assessing young peoples awareness as regards car accident prevention and misleading behaviours. The survey concerned a sample of 829 high school students of both genders, aged 17 to 23, from a chief town (Catania) and a country town (Noto, Siracusa). In addition to a good level of awareness as regards road accidents and misleading behaviours, the investigation also showed an opposite trend to disregard basic safety rules such as the use of helmets, safety belts and abstention from alcohol intake. Dangerous behaviours have shown to be higher in Noto than Catania, and more frequent among male than female of both towns. In the light of such results, some educational actions have been discussed for road safety.