A severe case of Aeromonas veronii biovar sobria travellers' diarrhoea characterized by Vibrio parahaemolyticus co-isolation.

We report a severe case of travellers' diarrhoea in a patient returning from Ecuador to Italy with the concomitant presence of Aeromonas veronii biovar sobria and Vibrio parahaemolyticus in their faeces. Based on diagnostic results, epidemiological information and the clinical outcome, we conclude that the real aetiological agent was A. veronii biovar sobria, while V. parahaemolyticus was only transient in the intestine of the patient.

[Loa loa filariasis in Italy: review of the literature with a clinical report]. / Filariasi da Loa loa in Italia: revisione della letteratura e descrizione di un caso.

We present the case of an asymptomatic Loa loa disease in a 28-year-old Nigerian man living in Italy for 5 years. The man was admitted to our clinic for an occasional identification of hypereosinophilia (white blood cell count 5440/mmc, eosinophil 42%) and the presence of microfilaria at an hemoscopic evaluation. The diagnosis was made by testing the diurnal peripheral blood that showed a parasitaemia of 7000 microfilia/mL. The patient was treated with ivermectin 12 mg on the first day followed by albendazole 400 mg every 12 hours for 21 days with a reduction but no negativization of the parasitaemia and no collateral effect. Filariasis should be considered in all patients who come from or have stayed in endemic areas or who present alterations in the leukocyte formula, including hypereosinophilia, or some unexplainable allergic disorders. The lab diagnosis can be conducted through a hemoscopic test or directly with the identification of the adult worm, whereas the parasitaemia can be evaluated only through a hemoscopic test. The therapy can be non-conclusive or carried out with difficulty as finding diethylcarbamazine may be a hard task or potentially fatal anaphylactic reactions may occur.

[Campylobacter enteritis and related organisms. Clinical microbiology and antibiotic resistance]. / Le infezioni intestinali sostenute da Campylobacter e generi affini: principali aspetti di microbiologia clinica e fenotipi di resistenza antibatterica.

The Authors underline the importance to always and correctly investigate also for Campylobacters and related organisms (Clo's) in faeces of humans with enteritis, because prevalent like Salmonella and for surveillance antibiotic resistances; in fact for campylobacteriosis specific therapy is often necessary. Between 2001 and 2005 248 strains of Campylobacter and Clo's were isolated: 225 were C. jejuni (90.7%) and 16 C. coli (6.5%). The recommended antibiotics to use for therapy, for preventing secondary effects too, are erythromycin, ciprofloxacin and tetracycline. Among C. jejuni, resistances towards erithromycine were 6.8% during 2001-02, 6.8% during 2003 and 4.8% during 2004-05; the resistances towards ciprofloxacin were 52.9% during 2001-02, 53.8% during 2003 and 42.9% during 2004-05; the resistances towards tetracycline were 39.2% during 2001-02, 46.2% during 2003 and 50.0% during 2004-05. The strains of C. coli showed less resistances, also in respect of previous our data too. No relevant differences were observed in antibacterial resistances among strains isolated from children and strains isolated from adults.

[Acute and prolonged infectious diarrheas, of microbial and viral etiology: methods of clinical and microbiological diagnosis]. / Enteriti acute e protratte a eziologia microbica e virale: metodologia operativa e percorsi diagnostici clinico-microbiologici.

The Authors relate clinical-microbiological criteria for a rational diagnosis of acute and prolonged enteritis, distinguishing between home and imported diarrheas. During 2005, 381 subjects (192 children and 189 adults) with acute diarrhea and 110 subjects (16 children and 94 adults) with prolonged diarrhea were examined. In the first group Salmonella prevailed in 11.1% of cases (10.9% among children and 11.1% among adults); Campylobacter in 9.2% (respectively 8.9% and 9.5%); other bacteria were identified in 3.2% of cases (1.0% and 3.8% respectively). Rotavirus were observed in 29.5% of children and Adenovirus in 6.2% of pediatric population. Pathogenic protozoa were observed in 1.6% of people (0.5% in children and 2.7% in adults). Among second group pathogenic protozoa prevailed in 6.4% (6.3% in children and 6.4% in adults); toxin A of C. difficile were detected in 8.5% of total cases. The Authors emphasize the importance to investigate always for Salmonella, Shigella and Campylobacter; in children with vomiting (with acute non invasive enteritis) is necessary to investigate for Rotavirus too; if the diarrhea is prolonged could be important investigate for toxin A/B of C. difficile and for protozoa with specific stains. Based on clinical and epidemiological findings other pathogens could be researched, if possible for own resources.

[Preliminary survey of human intestinal parasitosis in a Peruvian Andean zone]. / Sondaggio preliminare copro-parassitologico in una zona andina del Perù.

We studied 91 faecal specimens of 38 children and 53 adults in a five-day epidemiological survey between the end of February and the beginning of March, 2006. The subjects were in- or out-patients of Chacas Hospital, Ancash. The O&P were performed with macroscopic evaluation, microscopic (direct and after formalin-ether concentration, FEA) observations and Giemsa permanent stain of all faecal samples. 61 subjects (67.0%) were infected with parasites (25 children, 65.5%, and 36 adults, 67.9%). D. fragilis was prevalent in 30.8% of subjects (28.9% of children, 32.1% of adults); G. duodenalis was observed in 12.1% of cases (21.1% of children and 5.7% of adults); A. lumbricoides was observed in 15.4% of cases (18.4% and 19.9% respectively); other helminths were identified in 7.7% of cases (10.1% and 5.7% respectively); non-pathogenic protozoa alone were observed in 23.1% of cases (28.9% among children and 19.9% among adults). D. fragilis was more frequent among females (44.7% vs. 20.8%), while G. duodenalis and A. lumbricoides among males (13.2% vs. 10.5% and 17.0% vs. 13.2% respectively). We emphasize the usefulness of both FEA and Giemsa permanent stain for a good O&P.

[Intestinal infections caused by Dientamoeba fragilis and Giardia duodenalis in our experience]. / Attualità in tema di infezioni intestinali causate da Dientamoeba fragilis e Giardia duodenalis.

Between 2002 and 2003 the Authors analyzed stool specimens of 1,989 subjects, 966 children (1-14 years old) and 1,023 adults, to investigate for intestinal protozoa too: 380 children and 656 adults with intestinal aspecific troubles, 546 children and 291 adults with acute diarrhoea, 40 children and 76 adults with prolonged diarrhoea. G. duodenalis prevailed in 1.8% of all cases (0.2% among children and 3.2% among adults), D. fragilis in 4.1% (0.6% and 7.3% respectively). Other pathogenic parasites were very rare. Only B. hominis (opportunistic/saprophytic protozoon) or other commensal protozoa were observed, also associated with D. fragilis and/or G. duodenalis. Among subjects suffering from intestinal aspecific troubles, G. duodenalis prevailed in 3.7% and D. fragilis in 8.7% of adults; both protozoa were observed in 0.5% of children each one. Among acute diarrhoeas G. duodenalis was observed in 1.7% of adults and never in children, D. fragilis in 4.5% and 0.4% respectively. Among prolonged diarrhoeas, G. duodenalis was observed in 5.3% of adults and never in children, D. fragilis in 6.6% of adults an in 5.0% of children. The Authors emphatyze the clinical importance of D. fragilis and the diagnostical importance of a permanent stain, like Giemsa, for a good and sure diagnosis.

[Role of Dientamoeba fragilis in human bowel infections]. / Dientamoeba fragilis: suo ruolo nelle infezioni intestinali umane.

During 2004, we identified 39 intestinal infections caused by Dientamoeba fragilis and 23 caused by Giardia duodenalis, on 1141 home subjects (3.4% and 2.0% respectively): D. fragilis was observed in 4.5% of O and P (29/644 subjects suffering from aspecific bowel disorders) and in 2.0% of diarrhoeas (10/497); G. duodenalis was observed in 3.1% (20/644) and in 0.6% (3/497) of cases respectively. No other pathogenic parasites were identified (only 1 case of enterobiasis in an asymptomatic child). Commensal protozoa were observed, among O and P, in 4.3% of cases (28/644). The non-pathogenic B. hominis, often associated with other protozoa, was observed in 4.1% of all 1141 cases. D. fragilis is undoubtedly more frequent in adults (36/39 cases, 92.3%) than in children (3/39, 7.7%), and is prevalent among females (24/39, 61.5%) in respect of males (15/39, 38.5%). G. duodenalis is more prevalent among adults (16/23, 69.5%) than children (7/23, 30.5%), but is more frequent among males (13/23, 56.5%) than females (10/23, 43.5%). Clinical correlations of dientamoebiasis and giardiasis are reported, seasonal and epidemiological features of these protozooses are outlined, and the authors emphasize the importance and need of Giemsa stain, among O and P and acute or prolonged diarrhoeas, on the basis of previous good direct microscopic observations of faecal specimens, for correct and complete diagnosis of intestinal infections.

[A case of ophthalmomyiasis: description and diagnosis]. / Miasi congiuntivale da Oestrus ovis: descrizione di un caso,considerazioni generali e indicazioni diagnostico-epidemiologiche.

The authors describe a human case of ophthalmomyiasis caused by the "sheep fly" Oestrus ovis larva. They emphasize the importance of collaboration between practitioner or specialist and parasitologist for a sound, definitive aetiological diagnosis of such uncommon pathologies.

[Coryneform bacteria: their clinical significance and resistance patterns during a three-year study]. / Corinebatteri e corineformi: ruolo eziologico in pazienti ospedalizzati e fenotipi di resistenza nel corso di 3 anni di osservazione.

We report data concerning our experience during three years (1998-2001) about isolation, identification and susceptibility towards antimicrobial agents of coryneform bacteria in infections of hospitalized/at risk patients. We isolated 54 Corynebacterium spp., with prevalence of C. striatum (8 strains) and C. amycolatum (7 strains), and 1 strain of Oerskovia spp. and 1 strain of Actinomyces neuii. 31 strains were isolated from the "exit-site" and 6 from peritoneal fluid of CAPD patients. Vancomycin and teicoplanin were always "in vitro" efficacious. Resistance rates towards other antibiotics were the following: 11% for minocycline, 12.5% for tetracycline, 20% for gentamicin and netilmicin, 61% for erythromycin and chloramphenicol, 66% for penicillin.

[Pharyngotonsillitis caused by Streptococcus pyogenes: clinical and epidemiological aspects and resistance phenotypes towards macrolides]. / Faringotonsilliti da Streptococcus pyogenes: aspetti generali clinico-epidemiologici e fenotipi di resistenza nei confronti dei macrolidi.

During 2001 we analyzed 1730 pharyngeal swabs for S. pyogenes (SGA): 1142 children (0-10 years old), 132 adolescent subjects (11-17 years old), and 456 adults (18 or more years old). 994 subjects (664 children, 85 adolescent ones, 245 adults) had acute pharyngotonsillitis. In this last group we observed 321 positivities (32.3 %) for SGA: 40.4 % among children, 24.7 % among adolescent people, 13.1 % among adults. The pharyngotonsillitis prevailed during winter and spring. The resistances (R) towards erythromycin were 27.7 % (89 cases), and among children 30.6 % (82 cases), towards clyndamicin 15.3 % (49 cases, and 17.2 %, 46 cases, among children), towards rokytamicin 11.8 % (38 cases, and 13.1 %, 35 cases, among children). These were the phenotypes of R to erythromycin: 25.8 % M-phenotype, 19.1 % inducible (iMLS), 55.1 % constitutive (cMLS); among children respectively 25.6 %, 18.3 % and 53.7 %. Increased resistances towards 16-C macrolides, increased resistances of cMLS to erythromycin, and the persistence of R to 14-C macrolides around 30 % are discussed.

[Enteric infections in Perugia's area: laboratory diagnosis, clinical aspects and epidemiology during 2001]. / Diarree acute e protratte nella popolazione del territorio perugino: diagnosi microbiologica delle enteriti ed aspetti clinico-epidemiologici relativi al 2001.

During 2001 we analyzed 523 stool specimens (330 children, 193 adults) of patients with recent diarrhoea. We processed all specimens for protozoa, rotavirus, adenovirus, toxin A of C. difficile, and usual enteropathogen bacteria. Salmonella prevailed in 12.8% of cases (16.4% among children, 6.7% among adults), Campylobacter in 9.9% (11.5% and 7.3%), C. difficile toxin A producer in 11.3% (13.7% and 8.1%); other bacteria generally prevailed in 2.4%, protozoa in 2.7%. Among children rotavirus prevailed in 41.4%, adenovirus in 3.6%. Enteritis prevailed in children between 1 and 6 years of age. All pathogens were reported during all the seasons, but salmonellosis and campylobacteriosis were more frequent during spring and summer, rotavirus infections during the winter. Non particular and/or specific correlations could be observed between clinical manifestations and pathogen agents; anyway only bacteria were identified among invasive enterites. Vomitus was more frequent in rotavirus infections. Finally the Authors suggest a rational and efficacious methodology for diagnosis of presumptive infectious diarrhoeas.