Case Report. Multiple etiology post-surgery endophthalmitis.

The case describes a septic endophthalmitis arisen in a convalescence period following surgery of cataract extraction. The infection was due to Staphylococcus aureus and three fungal components, Candida albicans, Candida glabrata and Acremonium kiliense, which were subsequently isolated. A careful and prompt laboratory investigation allowed the clinicians to adjust the antimycotic therapy and attain an excellent clinical result.

Diphtheria antitoxin levels in the 14-30-year age group in Italy.

In order to verify diphtheria immunity a seroepidemiological survey was performed in 1996-1997. Serum samples were obtained from 501 subjects 14 years old, recruited at 8 schools in Rome, and from 490 subjects 20-30 years old recruited from 15 Italian regions. Serum diphtheria antitoxin was titrated using the Vero cell assay. The minimum protection level of antitoxin was set at 0.01 IU ml-1. The results show that the younger population have a good immunity to diphtheria while a large proportion of young adults is devoid of protective levels of diphtheria antitoxin. Out of the 501 subjects 14 years old, 495 (98.8%) had a diphtheria antitoxin titre > or = 0.01 IU ml(-1). Only 6 (1.2%) teenagers were susceptible. Out of the 490 subjects 20-30 years old, 109 (22.2%) were susceptible, 381 (77.8%) had a diphtheria antitoxin titre > or = 0.01 IU ml(-1). The data stress for booster immunization at the end of junior high school.

Immunity status against poliomyelitis in persons 13-14 years old living in Rome.

The immunity against poliomyelitis in 1000 subjects 13-14 years old was evaluated. Neutralizing antibodies against poliovirus type 1, 2 and 3 were detected in 97.6%, 95.8% and 70% of samples, respectively. 3/1000 (0.3%) subjects were simultaneously seronegative to the three types. WHO does not suggest a protective level of International Units (IU), but our data indicate that such level is 0.45 IU for polio type 1, 0.65 IU for the type 2 and 0.138 for the type 3. A booster dose of vaccine in adolescence to ensure personal and herd immunity is recommended.

Immune response of the elderly to rabies vaccines.

A serological study has been performed to detect the antibody response to full schedules of two anti-rabies vaccines (PDEV and HDCV). Subjects aged > 50 years, compared with subjects 11-25 years, showed significantly lower titres after the 4th dose (and, to a lesser extent, after the 5th dose), suggesting that, among the elderly, the 6th dose is strongly desirable.

Viral hepatitis and drugs: a continuing problem.

A seroepidemiological survey of a group of drug abusers has been carried out to determine the prevalence of hepatitis C virus and hepatitis B virus, hepatitis D virus, hepatitis A virus infection markers in sera, as well as to evaluate the role of potential risk factors. A total of 645 symptomless subjects with a history of injecting heroin were recruited as volunteers from methadone maintenance centres in Rome. For all hepatitis viruses the total figures showed high prevalence rates giving considerable viral circulation in this group. Among heroin addicts the prevalence was 63.4% for HCV, 65% for HBV, 13.3% for HDV and 50.9% for HAV. Anti-HCV prevalence correlated with serological evidence of HBV infection. A significant correlation was also found between presence of HCV antibodies and exposure time to drug addiction > 5 years earlier. The data reveal the important role played by needle sharing in the spreading of multiple infections among intravenous drug abusers (IVDA).

[Tetravalent anti-meningococcal vaccine: serologic and clinical evaluation]. / Vaccino antimeningococcico tetravalente: valutazione sierologica e clinica.

Meningococcal disease is the only bacterial meningitis able to cause an epidemic and the mortality due to this disease is all but negligible; therefore the active immunization induced by a vaccine that includes a large portion of Neisseria meningitidis serogroups responsible for the immunization of subjects at risk. Tetravalent vaccine containing polysaccharides of the serogroups A, C, Y, W135 has given good results both for tolerability and immune response. Considering the epidemic situation in Italy, this vaccine could be an excellent strategy "to behead" possible epidemics and/or hyperendemics due to a known serogroups.

Lymphocyte proliferative response to rabies virus antigen.

Rabies virus (RV) infection, as well as active immunisation using viral antigen, elicit both humoral and cellular reactions whose protective effects are still unclear. We evaluated both responses in order to find valuable monitoring parameters for the immunisation procedure. Three laboratory workers repetitively immunised with booster human diploid cell vaccine against rabies virus, 13 patients from the anti-rabies centre (vaccinated for the first time) and 10 healthy volunteers (not immunised nor exposed to rabies virus antigen), were monitored for: (i) in vivo RV-specific antibody production; (ii) in vitro anti-RV lymphocyte proliferative response and (iii) in vitro phenotype modulation induced by the viral antigen. In particular CD3, CD4, CD8, and surface immunoglobulins were monitored. All 3 subjects receiving the booster immunisation and, to a lesser extent, those receiving 4 doses of vaccine did recognise the antigen in vitro. The proliferation involved mainly CD4 positive cells leading to an increased number of cell bearing surface immunoglobulins, i.e. B cells. The proliferation index was in good correlation with the in vivo antibody production (p = less than 0.00009441). Nevertheless the presence of some cases without correlation between those parameters (in particular 5 out of 6 patients over 65 years of age failed to mount an adequate cellular proliferative response) reveals the need to use cellular response in parallel to the current humoral response, in order to evaluate and monitor the immunisation procedure. This conclusion is further stressed by the fact that protection against rabies infection is mainly cellular.