Candida chorioretinitis in meningococcal meningitis.

A case of Candida chorioretinitis in a patient suffering from meningococcal meningitis, admitted to the Infectious Disease Department of Frosinone Hospital, Italy, is reported. Five days after the onset of meningitis during antibiotic and cortisone treatment the patient experienced oropharyngeal candidiasis, ocular pain and blurring of vision; two days later positive scotoma appeared. Ophthalmoscopic examination revealed probable Candida chorioretinitis. Treatment with intravenous fluconazole at high doses was employed with complete recovery of the right eye, while visual acuity of the left eye was 2/10. The use of long-term fluconazole at the doses reported, commonly employed in the treatment of systemic mycoses, improves prognosis.

Incidence of Legionella pneumophila infection in tourists: Italy.

Legionella pneumophila has frequently been recognised as a cause of infection in tourists. From 1973 to 1987, 117 cases of legionellosis were reported in tourists who spent one or more weeks in Italian summer resorts. 6 (5.1%) patients died. 42 (35.9%) were sporadic cases, and 75 (64.1%) were related to clusters or outbreaks. Among the 117 cases, 63 were reported to the Istituto Superiore di Sanità by the health authorities of other countries. Some travellers became ill while in Italy, others soon after they returned home. All tourists but two had stayed in hotels. L. pneumophila was isolated from the water system of 10 hotels, and in another hotel the same Legionella species was detected by direct immunofluorescence. Persistent and/or recurrent sources of infection seem to be present in some summer resorts on the Adriatic Coast and in the Lake Garda area in northern Italy. Some groups of cases were associated with particular hotels over a period of several months and sometimes years. Investigations have implicated potable water as the likely vehicle and the source of infection for tourists. The need of a greater awareness amongst clinicians that travel is a risk factor for legionellosis, and for better international surveillance and cooperation, is stressed.

[Results of neonatal vaccination against hepatitis B in Frosinone]. / Risultati della vaccinazione neonatale antiepatite B a frosinone.

Neonates born to HBSAg-positive mothers are at increased risk of HBV, mainly because of perinatal exposure. Since 1985 the HBV Regional prevention and control program of Latium recommends prophylaxis both with HBIG and HBV vaccine at birth for all infants born to HBaAg-positive mothers. From 1-1-80 to 1-5-88 89 neonates (52 males, 37 female) from Local Health Units (U.S.L.) FR 2, 3, 4, 5, 6, 7, 8, 9 have been examined at the Centre for Vaccination against HBV of Frosinone. Prophylaxis was accomplished both by HBIG 1 ml. I.M.) at birth and HBV vaccine (5.5 ml. I.M. of HBVAX) at birth, and at 1 and 6 months. All injections were given in the gluteal muscle. Antibody titer to HBsAg (antiHBs) detectable by RIA was tested 1 month after or by the time of the third injection of vaccine. Non-responders (anti HBs less than 10 mUI/ml) were given an extra dose of vaccine (0.5 ml I.M.). 85 neonates accomplished vaccination receiving three injections of HBVAX; 4 neonates received only one dose as their parents refused to continue vaccination. Two neonates (non-responders) out of 85 required another dose of vaccine, but only one seroconvertion appeared. No serious side effects have been seen: one case of anorexia and one case of low-grade fever, with no need to interrupt or modify immunization schedule. In the present study the prophylactic efficacy of HBV vaccine has been demonstrated providing 98.6% of cases with antiHBs titer greater than or equal to 10 mUI/ml, and 84% of cases with antiHBs titer greater than or equal to 150 mUI/ml.(ABSTRACT TRUNCATED AT 250 WORDS)

[Microbiological control of hospital infections]. / Controllo microbiologico delle infezioni ospedaliere.

In the recent years there is a growing interest in Nosocomial Infections in Italy, because of current studies providing useful information on hospital epidemiology, hospital cost and infection control measures. Besides there is an increasing awareness that clinical and epidemiologic data provide a more important support for infection control program than microbiologic data, which are not always required to identify Nosocomial Infections. Still a reliable microbiology laboratory is an integral support system for infection control program, contributing information on Nosocomial Infection Surveillance and Education of personnel. Over the past five years in the Hospital of Frosinone, prevalence and incidence studies on patient population and microbiologic monitoring were performed. All investigations were accomplished by the Hospital Infection Control Team by collecting and reporting data on special forms, since 1988 information on microbial cultures were included. The prevalence and incidence studies have demonstrated few microbial isolates compared to the number of infections identified. Antibiotic monitoring is considered an integral component of Infection Control Programs, contributing to the surveillance of emerging resistance. All data concerning microbial isolates have been routinely an orderly collected and tabulated. A three-monthly report is distributed throughout the hospital and pertinent data are briefly reviewed. This simple method of surveillance is used to identify trends in problem areas, support antibiotic policy statements and serve as a focus for educational programs of personnel. These routine studies have some limitation: 1) all microbial agents are considered, irrespective of nosocomial infection cases; 2) 100-120 hours of work from an infection control nurse are required. Therefore microbial data are not adequate in containing Nosocomial infections, if not supported by Infection Control Team's investigation.

Hepatitis B in two Italian General Hospitals.

A study to evaluate the extent of Hepatitis B among Hospital Staff in two hospitals in central Italy, blood tested 1212 individuals (80.2% of the staff). 33.7% of staff tested was positive to at least 1 marker of prior B hepatitis infection. The study confirms that B hepatitis is an occupational hazard for those exposed to blood. Specific risks in terms of odds ratios are estimated to be about 2.0 for professional nurse compared to other nursing categories, about 1.7 for staff in high risk departments compared to low risk departments and about 5.0 for professional nurses in high risk departments compared to clerks or nurses aides in low risk departments. The computation of attributable risk indicates that working in a hospital contributes only a minor fraction of the total national burden of this disease. However, immunization of hospital workers in Italy can prevent every year as many as 6,500 new Hepatitis B infections in this high risk group.