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1.
IDCases ; 33: e01878, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37680213

RESUMO

Vibrio cholerae represents diverse species and includes pathogenic and non-pathogenic variants. Particularly serogroups O1 and O139 are related to cholera epidemics, while non-O1/O139 serogroups (NOVC) in general are non-pathogenic or asymptomatic colonizers in humans, but also can cause different diseases. Vibrio albensis, a non-O1/non-O-139 serogroup, is rarely implicated in human infections. Only a few cases of human pathology related to this species are described in the literature. We present the menagement of V. albensis gastroenteritis in a a 47-year-old woman and discuss clinical presentation, diagnosis and treatement.

2.
Case Rep Infect Dis ; 2019: 7403878, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827952

RESUMO

Histoplasma capsulatum is a dimorphic fungus, endemic in the Americas, Africa (var. duboisii), India, and Southeast Asia. H. capsulatum infection is rarely diagnosed in Italy, while in Latin America, progressive disseminated histoplasmosis (PDH) is one of the most frequent AIDS-defining illnesses and causes of AIDS-related deaths. We report a case of PDH and new HIV infection diagnosis in a Cuban patient, who has been living in Italy for the past 10 years. Bone marrow aspirate and peripheral blood smear microscopy suggested H. capsulatum infection. The diagnosis was confirmed with the culture method identifying its thermal dimorphism. Liposomal amphotericin B was administered alone for 10 days and then for another 2 days, accompanied with voriconazole; the former was stopped for probable side effects (persistent fever and worsening thrombocytopenia), and voriconazole was continued to complete 4 weeks. PDH maintenance treatment consisted of itraconazole for one year. Antiretroviral therapy (ART) was started on the third week of antifungal treatment. At the 3-year follow-up, the patient is adherent on ART, the virus was suppressed, and she has an optimal immune recovery. This case highlights the need to suspect histoplasmosis in the differential diagnosis of opportunistic infections in immunocompromised persons, native to or who have traveled to endemic countries.

3.
Thromb Haemost ; 110(2): 349-57, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23703656

RESUMO

Abacavir (ABC) has been associated with ischaemic cardiovascular events in HIV-infected patients, but the pathogenic mechanisms are unknown. Aim of our study was to assess whether ABC induces in vivo platelet activation and ex vivo platelet hyper-reactivity. In a retrospective, case-control study, in vivo platelet activation markers were measured in 69 HIV-infected patients, before starting therapy and after 6-12 months of either ABC (n=35) or tenofovir (TDF) (n=34), and compared with those from 20 untreated HIV-infected patients. A subgroup of patients was restudied after 28-34 months for ex vivo platelet reactivity. In vivo platelet activation markers were assessed by ELISA or flow cytometry, ex vivo platelet reactivity by light transmission aggregometry (LTA) and PFA-100®. Thein vitro effects of the ABC metabolite, carbovir triphosphate, on aggregation and intra-platelet cGMP were also studied. sPLA2, sPsel and sGPV increased significantly 6-12 months after the beginning of ABC, but not of TDF or of no treatment. Ex vivo platelet function studies showed enhanced LTA, shorter PFA-100® C/ADP closure time and enhanced platelet expression of P-sel and CD40L in the ABC group. The intake of ABC blunted the increase of intraplatelet cGMP induced by nitric oxide (NO) and acutely enhanced collagen-induced aggregation. Preincubation of control platelets with carbovir triphosphate in vitro enhanced platelet aggregation and blunted NO-induced cGMP elevation. In conclusion, treatment with ABC enhances in vivo platelet activation and induces platelet hyperreactivity by blunting the inhibitory effects of NO on platelets. These effects may lead to an increase of ischaemic cardiovascular events.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Didesoxinucleosídeos/efeitos adversos , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Ativação Plaquetária/efeitos dos fármacos , Adenina/efeitos adversos , Adenina/análogos & derivados , Adulto , Fármacos Anti-HIV/sangue , Plaquetas/efeitos dos fármacos , Plaquetas/metabolismo , Ligante de CD40 , Estudos de Casos e Controles , GMP Cíclico/sangue , Nucleotídeos de Desoxiguanina/efeitos adversos , Nucleotídeos de Desoxiguanina/sangue , Didesoxinucleosídeos/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Organofosfonatos/efeitos adversos , Selectina-P/sangue , Fosfolipases A2 Secretórias/sangue , Agregação Plaquetária/efeitos dos fármacos , Estudos Retrospectivos , Tenofovir
4.
Tumori ; 98(2): 220-4, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22677988

RESUMO

BACKGROUND AND AIMS: In hepatitis B virus (HBV) carriers receiving chemotherapy, the risk of reactivation is high, particularly if rituximab is given alone or in combination with steroids. The aim of this study was to assess the incidence, prevalence, and clinical course of HBV infection in a cohort of patients with hematological malignancies receiving cytotoxic therapy as well as to propose a strategy for managing HBV reactivation. METHODS: This is a prospective observational study. All consecutive patients with hematological malignancies receiving intravenous cytotoxic chemotherapy between October 2005 and June 2010 and followed up for at least six months were enrolled in the study. Viral hepatitis markers and liver function indexes were monitored prospectively. RESULTS: We enrolled 478 patients, including 263 males (55%) and 465 (97.3%) Italians. Non-Hodgkin's lymphoma was the most frequent diagnosis (66%). At least one HBV marker was positive in 96 patients (20%): 21 (4.4%) patients were HBsAg positive, 17 (3.5%) were anti-HBc positive, and 58 (12.1%) were anti-HBc/anti-HBs positive. All but one HBsAg-positive patient received therapy with nucleoside/nucleotide analogs prior to chemotherapy. All but three reached complete virological suppression at six months from the start of treatment. Of the 17 HBsAg-negative/anti-HBc-positive patients, three (18%) had reactivation with seroreversion. All three obtained viral suppression with adefovir. Regarding the 58 anti-HBc/anti-HBs-positive patients, two (3.4%) experienced seroreversion and were treated successfully with nucleoside analogs; both were taking rituximab. No severe ALT flares were observed during or after antiviral therapy. CONCLUSION: Our data suggest that pre-treatment screening of patients at risk of viral reactivation yields benefit and therefore should be practiced by clinicians treating patients with malignancies.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Antivirais/uso terapêutico , Vírus da Hepatite B/fisiologia , Ativação Viral , Adenina/análogos & derivados , Adenina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Quimioterapia Combinada , Feminino , Hepatite B , Antígenos de Superfície da Hepatite B/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Organofosfonatos/uso terapêutico , Estudos Prospectivos , Recidiva , Rituximab , Resultado do Tratamento
6.
AIDS ; 23(5): 589-96, 2009 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-19177019

RESUMO

OBJECTIVE: Ischemic cardiovascular events increasingly occur during long-lasting HIV infection and are attributed either to the infection itself or to the use of HAART. Endothelial dysfunction and platelet activation are markers of atherosclerosis. Our aim was to assess whether patients with chronic HIV infection present endothelial dysfunction and whether this is the consequence of infection or of HAART. DESIGN: Fifty-six HIV-infected patients were studied in a retrospective cohort study before and 3, 6, 12 and 24 months after starting HAART with protease inhibitors (n = 28) or nonnucleoside reverse transcriptase inhibitors (n = 28), and compared with 28 age-matched and sex-matched healthy controls, and with 10 naive HIV-infected patients studied at diagnosis and after 12 months of untreated infection. METHODS: Soluble endothelial and platelet activation markers were measured in plasma by flow cytometry. RESULTS: Soluble P-selectin, soluble vascular cell adhesion molecule-1, monocyte chemoattractant protein-1 and von Willebrand factor were significantly higher in HIV-infected patients than in healthy controls, whereas soluble CD40 ligand and tissue type plasminogen activator were within normal range. During follow-up, soluble vascular cell adhesion molecule-1, monocyte chemoattractant protein-1 and von Willebrand factor but not soluble P-selectin decreased progressively, without significant differences between protease inhibitors and nonnucleoside reverse transcriptase inhibitors treatment. In naive, untreated patients, increased plasma markers of endothelial dysfunction were confirmed at diagnosis, with no changes upon follow-up. CONCLUSION: Chronic HIV infection, and not its pharmacological treatment, induces alterations of markers of endothelial function. Short-term treatment with HAART reduces some markers of endothelial dysfunction, with no differences between protease inhibitors and nonnucleoside reverse transcriptase inhibitors.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Aterosclerose/virologia , Endotélio Vascular/fisiopatologia , Infecções por HIV/complicações , HIV-1 , Adulto , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/farmacologia , Aterosclerose/induzido quimicamente , Biomarcadores/sangue , Contagem de Linfócito CD4 , Endotélio Vascular/efeitos dos fármacos , Métodos Epidemiológicos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/fisiopatologia , Infecções por HIV/virologia , Inibidores da Protease de HIV/efeitos adversos , Inibidores da Protease de HIV/farmacologia , HIV-1/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Ativação Plaquetária/efeitos dos fármacos , Ativação Plaquetária/fisiologia , RNA Viral/sangue , Inibidores da Transcriptase Reversa/efeitos adversos , Inibidores da Transcriptase Reversa/farmacologia , Carga Viral , Adulto Jovem
7.
Recenti Prog Med ; 99(2): 89-92, 2008 Feb.
Artigo em Italiano | MEDLINE | ID: mdl-18459683

RESUMO

Over the last years the proportion of old individuals infected with HIV is increasing. Epidemiological data show that HIV-infected patients is ageing in parallel with the use of potent treatment and that the number of older patients who are newly diagnosed is increasing. Older people have a higher prevalence of sexual HIV transmission and the infection tend to be diagnosed at an advanced stage. Management of HIV infection in older patients is particularly complex for presence of co-morbidities that may be worse the antiretroviral treatment (ART) associated toxicity. Information campaigns targeting older patients and their doctors are needed to ensure timely diagnosis of HIV infection and ART.


Assuntos
Infecções por HIV/tratamento farmacológico , Idoso , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade
8.
J Infect ; 56(1): 58-64, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-17905438

RESUMO

OBJECTIVES: Tipranavir (TPV) is a non-peptidic protease inhibitor (PI) that represents one of the latest options approved in the salvage setting for HIV-infected multi-drug resistant patients. In this study, we explored whether TPV affects virulence of opportunistic fungi such as Cryptococcus neoformans and Candida albicans. METHODS: C. neoformans and C. albicans were cocultured in the presence or absence of TPV for various time periods. Subsequently, growth inhibition, phospholipases, proteases and capsule size were examined. In selected in vivo experiments, TPV was administered in immunocompetent and immunosuppressed mice. Survival rate and colony forming units from organs were evaluated in mice systemically challenged with C. neoformans or C. albicans. RESULTS: Indeed, when cultured in the presence of TPV, both fungi showed significant reduction in protease and phospholipase production, but TPV showed an opposite effect on the major virulence factors of C. neoformans and C. albicans by inhibiting capsule while promoting mycelial transition, respectively. TPV impaired in vitro growth of C. neoformans, but not of C. albicans. Moreover, TPV-treated C. neoformans, but not C. albicans, resulted more susceptible to killing by human neutrophils. Finally, TPV showed a therapeutic effect in experimental systemic cryptococcosis, as evaluated by reduced fungal burden in brain and liver of immunocompetent and immunodepressed mice. CONCLUSIONS: These new data indicate that TPV could act in multiple ways by diversifying its effects on various opportunistic pathogenic fungi.


Assuntos
Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida albicans/efeitos dos fármacos , Criptococose/tratamento farmacológico , Cryptococcus neoformans/efeitos dos fármacos , Piridinas/farmacologia , Piridinas/uso terapêutico , Pironas/farmacologia , Pironas/uso terapêutico , Animais , Encéfalo/microbiologia , Candida albicans/isolamento & purificação , Candida albicans/patogenicidade , Candida albicans/fisiologia , Parede Celular/efeitos dos fármacos , Criptococose/microbiologia , Cryptococcus neoformans/isolamento & purificação , Cryptococcus neoformans/patogenicidade , Cryptococcus neoformans/fisiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Fígado/microbiologia , Camundongos , Camundongos Endogâmicos BALB C , Micélio/metabolismo , Neutrófilos/imunologia , Peptídeo Hidrolases/biossíntese , Fagocitose , Fosfolipases/biossíntese , Células-Tronco , Sulfonamidas , Virulência/efeitos dos fármacos
10.
Haematologica ; 91(7): 980-2, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16818288

RESUMO

The prevalence, incidence and clinical course of viral hepatitis were prospectively determined in consecutive recipients of T-cell depleted hematopoieic stem cell transplants (49 mismatched, 60 matched, mean age 38 years; range 11-65). The prevalence of hepatitis B virus (HBV) was 15.6% and that of hepatitis C virus was 3.7% (HCV). HBV reactivated in one patient. Another developed ex novo acute hepatitis B which progressed to chronic hepatitis. There were no new cases of hepatitis C or worsening of pre-transplant HCV infections. HBV and HBC did not affect the outcome of T-cell depleted hematopoieic stem cell transplantation. Surveillance is important given the risk of HCV and HBV infection and/or reactivation and the efficacy of the new anti-hepatitis drugs.


Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hepatite B/etiologia , Hepatite C/etiologia , Adolescente , Adulto , Idoso , Criança , Transplante de Células-Tronco Hematopoéticas/métodos , Histocompatibilidade , Humanos , Incidência , Depleção Linfocítica , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Transplante Homólogo , Resultado do Tratamento
11.
Clin Neurol Neurosurg ; 104(2): 132-5, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-11932043

RESUMO

In this paper, we describe a case of an immunocompetent patient with cerebral nocardiosis. The onset was with loss of strength, paresthesia and focal epilepsy of the left arm. MRI showed on T2-weighted sequences a hyperintense central area of pus surrounded by a well-defined hypointense capsule and surrounding edema; on T1-weighted sequences a hypointense necrotic cavity with ring enhancement following administration of intravenous gadolinium. The patient underwent surgical excision of the abscess but culture from the specimen was negative. After 40 days of empirical antimicrobial therapy he developed neurological deterioration with focal epilepsy. A new MRI documented an enlargement of the hypointense lesion in the right frontal-parietal region. A second craniotomy with drainage of the abscess was performed; cultures yielded Nocardia farcinica. Therapy with trimethoprim/sulfamethoxazole, amikacin and meropenem was given for 35 days, and clinical and radiological improvement was observed. Home therapy was done with oral trimethoprim/sulfamethoxazole. Currently, 5 months from the second surgery, the patient can walk with support and no new episodes of epilepsy occurred. Side effects were absent from therapy. The MRI appearance of the brain lesion has improved, with a decrease in size, surrounding edema and ring enhancement.


Assuntos
Abscesso Encefálico/imunologia , Epilepsias Parciais/etiologia , Nocardiose/complicações , Abscesso Encefálico/patologia , Abscesso Encefálico/cirurgia , Edema Encefálico/etiologia , Epilepsias Parciais/microbiologia , Humanos , Imunocompetência , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Necrose , Nocardiose/patologia , Nocardiose/cirurgia
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