"Diagnosis on the Dock" project: A proactive screening program for diagnosing pulmonary tuberculosis in disembarking refugees and new SEI model.

OBJECTIVE: From 2011 to 2017, the total number of refugees arriving in Europe, particularly in Italy, climbed dramatically. Our aim was to diagnose pulmonary TB in migrants coming from the African coast using a clinical-based port of arrival (PoA) screening program. METHODS: From 2016 to 2018, migrants coming via the Mediterranean Route were screened for body temperature and the presence of cough directly on the dock: if they were feverish with productive cough, their sputum was examined with NAAT; with a dry cough, they underwent Chest-X-ray (CXR). Those migrants with positive NAAT or CXR suggestive for TB were admitted to our ward. In addition, we plotted an SEI simulation of our project to evaluate the epidemiological impact of our screening. RESULTS: Out of 33.676 disembarking migrants, 314 (0.9%) had fever and cough: 80 (25.47%) with productive cough underwent NAAT in sputum, and 16 were positive for TB; 234 (74.52%) with dry cough had a CXR examination, and 39 were suggestive of TB, later confirmed by mycobacterial culture. The SEI-new model analysis demonstrated that our screening program significantly reduced TB spreading all over the country. CONCLUSIONS: For possible future high migrant flows, PoA screening for TB has to be considered feasible and effective in decreasing TB spreading.

Disseminated Disease by Mycobacterium abscessus and Mycobacterium celatum in an Immunocompromised Host.

BACKGROUND Nontuberculous mycobacteria (NTM) are environmental pathogens that cause an increasing number of diseases, in particular in immunosuppressed patients. Diagnosing NTM infections may be difficult because clinical presentation is unspecific and resembles other conditions such as tuberculosis, lymphomas, or septicemia. CASE REPORT We report the case of a 62-year-old male with a recent history of autologous bone marrow transplantation for a follicular lymphoma admitted to our department for long-lasting remittent fever and abscess-like splenic nodules. The patient was diagnosed with mixed systemic infection by Mycobacterium abscessus and Mycobacterium celatum localized in spleen, bone marrow and kidneys. CONCLUSIONS In this case a rare disseminated atypical mycobacteriosis was diagnosed and treated. As far as we know this is the first case in the literature of M. abscessus localization either in the spleen or in the bone marrow. Our patient underwent a complex long-term therapy and had a complete resolution of the disease.

Skin and soft tissue infection by Mycobacterium intracellulare in an immunocompetent patient.

Nontuberculous mycobacteria (NTM) infections still represent a large group of insidious diseases hard to deal with. Traditionally, immunocompromised patients suffer from NTM infections, especially with respiratory involvement or disseminated diseases due to MAC (Mycobacterium avium complex). Here we report a rare case of Mycobacterium intracellulare infection involving skin and soft tissue, manifested as a chronic cutaneous ulcer in an immunocompetent patient with several comorbidities, including seizures. Accurate diagnosis of species was obtained with in vitro culture and RT-PCR (Real Time-Polymerase Chain Reaction) following a high clinical suspicion. Despite the high complexity of NTM infections, it is possible to achieve diagnostic goals through the appropriate employment of recent DNA-molecular technologies and an adequate management.

Rapid emergence of cryptococcal fungemia, Mycobacterium chelonae vertebral osteomyelitis and gastro intestinal stromal tumor in a young HIV late presenter: a case report.

BACKGROUND: Highly active antiretroviral therapy has significantly changed the natural history of HIV infection, leading to a dramatic reduction of HIV-related morbidity and mortality. Late Presenters, Very Late Presenters and AIDS presenters still represent, also in Europe, including Italy, a huge challenge in terms of diagnostic and therapeutic management. CASE PRESENTATION: A 35-year-old male with a history of fever and back pain. HIV test resulted positive with a high HIV Viral Load and a very low T-CD4 number of cells (5 cells/mm3). Imaging investigations revealed multiple vertebral and pulmonary lesions together with abdominal and thoracic lymphadenopathy. Blood cultures were positive for Cryptococcus neoformans and for Staphylococcus haemolyticus. Lymphnode biopsy resulted positive in PCR for Non-Tuberculosis Mycobacteria (Mycobacterium chelonae). A gastric biopsy also revealed a GIST. The patient also had CMV DNA positive. Although we performed antiretroviral therapy and specific-therapies for each disease, he was transferred to intensive care unit where he died due to an Acute Respiratory Distress Syndrome. CONCLUSION: The reported case is unusual due to the relevant number of opportunistic diseases (both infectious and tumoral) emerging not long after the HIV infection had been diagnosed. Late presenters HIV patients and AIDS presenters still represent a challenge, which is often too complex for clinicians to deal with. In spite of proper management, the risk of suboptimal results cannot be excluded.