[Strongyloides stercoralis in a region of northwestern Italy. An epidemiological note and presentation of a case of eosinophilic infiltration of the lung]. / Strongyloides stercoralis in una zona dell'Italia nord-occidentale. Note epidemiologiche e presentazione di un caso di infiltrazione eosinofila del polmone.

The Authors report a case of Strongyloides stercoralis infection in an autochthonous farmer from Piedmont (Northern Italy) presenting as an eosinophilic lung disease. After having briefly considered the epidemiological and clinical characteristics of the Strongyloides stercoralis infection, the Authors conclude by affirming that the appearance of migratory pulmonary infiltrates in autochthonous subjects or resident in Canavese area (Piedmont), especially if blood and sputum eosinophilia is present, should raise the possibility of Strongyloides-induced lung disease and lead to appropriate examination of sputum, feces, and eventually duodenal contents.

[Thoracic empyema caused by anaerobes. 78-month retrospective study. Clinical and microbiological aspects]. / Empiema toracico da anaerobi. Studio retrospettivo di un periodo di 78 mesi. Aspetti clinici e microbiologici.

The authors considered the microbiological and clinical aspects of the thoracic empyemas caused by anaerobic bacteria observed at the Ivrea-Castellamonte Hospital, Turin, over a period of 78 months. In this period 321 patients were subjected to thoracentesis in order to take samples of the pleural fluid (PF) which was in turn subjected to culture investigations. 31 patients (9.6%) had one or more cultures which were positive for bacterial growth. A good 12 patients (38.7%) had cultures which were positive for anaerobes alone or associated with aerobes. The average age of these patients (8 male, 4 female) was 62.5 years (range, 42 TO 84 Y.). Underlying diseases and predisposing conditions were as follows: malignancy (4 patients), neurological disorders (4p), severe hypoalbuminemia (5 p), bronchial obstruction (3 p), previous gastroenteric or chest surgery (3 p), diabetes mellitus (2 p), alcoholism (2 p), atherosclerosis (1 p), alveolar hypoventilation caused by chest wall disorder (1 p). The etiopathogenesis of the empyema was as follows; postpneumonic, 5 cases (41.7%); postsurgical, 4 cases (33.3%); esophageal fistula, 1 case (8.3%); idiopathic, 2 cases (16.7%). In 5 cases (441.7%) empyema developed in hospital, in 7 cases (58.3%) in community. Forty-one percent of the empyemas were described as foul-smelling. The anaerobic bacteria most frequently isolated were Bacteroides spp, Fusobacterium nucleatum, Peptostreptococci in this order. Thoracentesis was performed on 6 patients, chest tube drainage was required in 6, and antibiotics were administered to all the patients. Length of Hospitalization averaged 33>2 days. Three patients (30%) died. These patients died during the same hospitalization period while empyema was an active problem.(ABSTRACT TRUNCATED AT 250 WORDS)

[Osteolysis in an aged woman with recurrent urinary infections]. / Osteolisi in una donna anziana con infezioni urinarie recidivanti.

Hematogenous osteomyelitis has two incidence peaks; the first in childhood, the second in elderly people. The vertebrae are frequently involved in the case of elderly people and the diagnosis is difficult to make in as much as the radiological control of osteolysis is often attributed to malignant metastasis. The Authors describe a case of vertebral osteolysis in an elderly woman with relapsing urinary infections. The clinical history of the patient is described and the diagnostic procedure is critically discussed. In this way the diagnosis of osteomyelitis of the thorax-lumbar tract is reached. The Authors go on to consider the possibility of an infectious genesis of isolated osteolytic lesions, especially in patients with risk factors and ones prone to certain conditions such as urinary infections, above all because the complications of osteomyelitis can be extremely serious.

[Blastocystis hominis in Canavese: a retrospective study of samples received for fecal parasitological examination at the Ivrea- Castellamonte Hospital over 42 months]. / Blastocystis hominis in Canavese: uno studio retrospettivo sui campioni pervenuti per esame coproparassitologico all'ospedale di Ivrea-Castellamonte in un periodo di 42 mesi.

In the last ten years the interest in the controversial Blastocystis hominis microorganism of the intestine has greatly increased. The authors conducted a retrospective study of feces for parasitology investigations at the Ivrea-Castellamonte hospital. These investigations lasted 42 months (1/1/1988-31/6/1991) and the authors focused their attention on samples with 5 or more Blastocystis hominis at the microscopically examination with a 40X phase objective. During the study 2,138 samples of feces (belonging to 1552 patients) arrived. 284 samples (13.3%), corresponding to 200 patients (12.9%), proved to be positive for one or more parasites. In 155 samples (7.2%) regarding 109 patients (7.0%)--53 males, 56 females--Blastocystis was present. These patients were between 2 and 78 years of age. In 19 (17.4%) of these patients other parasites were associated, parasites such as Giardia lamblia (in 6 cases), Entamoeba coli (in 4 cases), Entamoeba spp. (in 2 cases), Entamoeba histolytica (in one case), Entamoeba hartmanni (in one case), Iodamoeba butschlii (in one case), Hymenolepis nana (in one case); helminths (in 3 cases). The most effect proved to be those patients between 21 and 50 years of age (53 of 98 patients). Few infants were affected. The greatest incidence of Blastocystis hominis infection occurred during the months of January to June. The authors conclude by considering how the incidence data of such parasitosis in the Canavese region can be superimposed on as much as has been observed in territories which are very different regarding social-economic and geoclimatic conditions. The authors think it is necessary to start a prospective clinical-epidemiological investigation in the Canavese region with a view to defining the clinical approach to the parasite under discussion in a better way.

[Bacteriology of abdominal pus in 43 cases of acute appendicitis and appendiceal abscess at the Ivrea-Castellamonte Hospital, isolation of aerobic and anaerobic bacteria and drug sensitivity]. / Batteriologia del pus addominale in 43 casi di appendicite acuta e ascessi appendicolari presso l'ospedale di Ivrea-Castellamonte, isolamenti di batteri aerobi ed anaerobi e sensibilità ai farmaci antimicrobici.

A retrospective study on the microbiology of abdominal pus from acute appendicitis or peritonitis was carried out by the authors. A total of 45 specimens were examined, 38 of them (84.4%) where found to be positive, of which 29 (76.3%) were polymicrobial and 9 (23.7%) were monomicrobial. The most represented species were Escherichia coli (28.4%), Bacteroides fragilis (7.8%), Streptococcus milleri (7.8%), Bacteroides oralis (3.9%) and Pseudomonas aeruginosa (3.9%). The polymicrobial associations more represented include Bacteroidaceae, Enterobacteriaceae and streptococcus genus. The most active drugs in vitro were found to be Piperacillin and Chloramphenicol, Cephalosporin (cefotaxime, ceftriaxone and cefoxitin) showed a good capability of being active against isolated microorganisms although they were less effective when used against anaerobic microorganisms then aerobic ones. On the contrary, Rifampicin, Metronidazole and Clindamycin were found to be quite effective against the anaerobes.

[Bacteremia and localized suppurative Salmonella non-typhi infections in the elderly: a study of 4 cases observed at the Ivrea-Castellamonte Hospital]. / Batteriemia ed infezioni suppurative localizzate da Salmonella non typhi negli anziani: uno studio di 4 casi osservati presso l'ospedale di Ivrea-Castellamonte.

Over a period of 60 months 137 cases of intestinal and extra-intestinal salmonellosis were registered in the microbiology department of the Ivrea-Castellamonte hospital. The authors conducted a retrospective study relative to the extra-intestinal salmonellosis manifested in elderly patients. In order to carry out such a study the authors considered only patients who were in the hospital, who were over the age of 65, and who had a clinical history different from the usual one of gastroenterocolitis. Out of 61 patients who were in hospital 50 were with complete registration data; 9 (18%) were over 65 years of age. The analysis of the clinical cards permitted the identification of 4 cases with unusual clinical histories due to the presence of serious systemic complications (sepsis with prolonged fever and positive blood cultures) or focal infections in extra-intestinal tissues (abscess of soft tissues, osteomyelitis). The authors focused their attention on these and described the general clinical characteristics of each patient, the type and the position of the isolated microorganism, the manifestations or extra-intestinal complications of the infection and the predisposing factors regarding the same complications. For each patient the essential clinical history and the treatment of the disease have been described. The authors conclude by affirming that in the cases of elderly patients with salmonellosis, apart from those infections in positions different from intestinal one, it would be opportune to consider an antimicrobe treatment also for enteritis infections and cases of asymptomatic infection.

[Gangrenous and perforating appendicitis in a provincial hospital: a 48-month retrospective study. Clinical and microbiological aspects, course and postoperative morbidity]. / Appendiciti gangrenose e perforate in un ospedale provinciale: uno studio retrospettivo di 48 mesi. Aspetti clinici e microbiologici, decorso e morbilità post-operatoria.

The appendectomy for gangrenous or perforated appendicitis is made more serious by a very high frequency of infection. The antibiotic prophylaxis should be able to reduce the frequency of such complications. We have considered retrospectively the patients who underwent appendectomy for gangrenous and perforated appendicitis in the period from June 1st, 1986 to May 31st 1990 in the Ivrea-Castellamonte hospital (Province of Turin), focusing our attention on certain microbiological and clinical variables in relation to the post-operative course. The average age of the 43 patients admitted to the study, 25 male adults and children and 18 female adults and children, was 27.4; the pediatric number totalled 22 subjects of which 14 male; the group of 21 adults included 11 males. 7 adults presented concomitant pathologies. The average stay in bed was 10.7 days (12.9 for the adults--8.6 for the children); 61.9% of the adults had a stay of more than 10 days, 72.7% of the children less than 10 days (P less than 0.05). The incidence of the infective complications in the whole group was 25.6% (33.3% of adults against 18.2% of children); infection of surgical wounds was observed in 18.6% of the cases (28.6% of the adults against 9% of children). The pre-operative antibiotic prophylaxis was activated in 22 patients (11 adults, 11 children) and the antimicrobic treatment was continued in the post-operative phase for an average of 7.3 days in the case of the adults and 5.9 days in the case of the children. Of the 21 patients not subjected to prophylaxis (10 adults, 11 children) all received post-operative antibiotic therapy (an average of 8 days for the adults, 7.8 days for the children). The incidence of septic complications in the group subjected to antibiotic prophylaxis was 18.2% as against 33.3% of the group not subjected; the incidence of infection of the wound being 13.6% against 23.8%. The per-operative cultures of pus coming from the peritoneum cavity were positive in 83.7% of the cases (53.5% mixed aerobe-anaerobe cultures). The microorganism most frequently isolated were: Escherichia coli (27.7%), Bacteroides fragilis (7.9%), other Bacteroides spp. (20.8%), among the positive gram aerobes the Streptococcus milleri (6.9%) prevails; the most common association is the between Bacteroides spp. and Enterobacteria (19 cases); in a good 17 cases the enterobacteriaceae is represented by the Escherichia coli; the Bacteroides, E. coli and Streptococcus association is, however, observed in 10 cases. Our study confirms the usefulness of the peri-operative antibiotic prophylaxis in the cases of a gangrenous or perforated appendicitis.

[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. I. Epidemiologic aspects]. / Batteriemie acquisite in comunità ed in ospedale: uno studio retrospettivo in un ospedale regionale. Nota I: Aspetti epidemiologici.

Data on all blood cultures from patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) from June 1986 to September 1989 were collected and processed in a retrospective study of the quantity of cultures prepared in the hospital as a whole and per department, the percentage of culture positivity and the incidence of bacteremias. The results were: 1) mean incidence of cultures: 12.37 per 1000 patients, increasing through the period; almost 2/3 of the cultures were requested by the three medical division; 2) positivity 21.2%; 3) incidence of bacteremias: 3 per 1000 patients. These findings are critically compared with others obtained both in Italy and abroad (United States, United Kingdom, South Africa), and it is suggested that the increased request for cultures observed should lead to an increase in the number of bacteremias diagnosed.

[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. II. Clinical observations]. / Batteriemie acquisite in comunità ed in ospedale: uno studio retrospettivo in un ospedale regionale. Nota II: Osservazioni cliniche.

A study was made of 92 bacteremia episodes among patients admitted to the Ivrea-Castellamonte Hospital (Turin, Italy) between June 1986 and September 1989. A single microorganism was isolated in 84 episodes (91.3%), the most common being: Staphylococcus aureus (21.7%), Escherichia coli (18.5%), Enterococcus (9.8%), Pseudomonas aeruginosa (6.5%), and Proteus mirabilis (5.4%). The episodes were of both hospital and community origin: 54.3% vs. 45.7%. Their main sources were: the urinary tract (16.3%), abdominal infections (14.2%), endocarditis (7.6%), and the respiratory tract (5.5%). No source could be identified in 26%. Brucellosis, salmonellosis and listeriosis together constituted 8.7% of the episodes. Abdominal infections were primarily responsible for the 8 cases (8.7%) of polymicrobial bacteremia. The overall mortality was 18.5% (6.5% community vs. 12% hospital episodes). Mortality directly due to bacteremia was 8.7%. Bacteremia was the direct or indirect cause of death in 22.6% of patients greater than or equal to 65, compared with 19% and 10% in those aged 35-64 and 15-44 respectively. The patient's clinical picture at the time of infection was a prognostic factor: mortality was much lower in subjects previously healthy or free from basic diseases (11.8%) than in those with non-rapidly-fatal diseases (21.7%) or rapidly-fatal diseases (54.5%). Bacteremia-linked mortality (direct and indirect) was higher in Gram-positive vs Gram-negative infections: 22.2% vs 15.8%. Mortality was 12.5% in the group of patients with polymicrobial infections.

[Strongyloidosis in Canavese: 4 cases seen at the 'Ospedale di Ivrea-Castellamonte. Epidemiological and clinical considerations]. / Strongiloidosi in Canavese: 4 casi osservati presso l'Ospedale di Ivrea-Castellamonte. Considerazioni epidemiologiche e cliniche.

From May 1988 to September 1990 the microbiology laboratory of the Ivrea-Castellamonte Hospital (Province of Turin) carried out 1464 coproparasitological investigations. 0.5% of the samples, coming from 5 patients, proved to be Strongyloides stercoralis positive. 4 cases were diagnosed in recovery conditions, and on these we carried out a retrospective study (taking into consideration some epidemiological and clinical aspects). The average age of these patients, three men and one woman, was 70.5; all native of the Canavese and resident in agricultural zones; two farmers still working, a worker and a retired worker. All of them presented one or more associated pathologies and/or a tendency to parasitosis. The clinical picture was characterized by abdominal pain, present in three cases, while diarrhoea was observed in only one case; a slight temperature in two, a high temperature in one; nettle-rash manifestations in one case and breathing symptomatology in two. In two cases there appeared abdominal relaxation (meteorism) and in one of these there was a serious paralytic ileus. Eosinophilia was present in all the patients, even if at different levels (from 5.9% to 20%). The treatment was carried out with different drugs: mebendazole in two cases, thiabendazole in one and "pyrvinium pamoate" in another. Our conclusion is that there exist in the Canavese the climatic, environmental and social-economical conditions which can favour Strongyloidiasis.

[Community- and hospital-acquired bacteremia: a retrospective study in a regional hospital. III. Microbiological aspects]. / Batteriemie acquisite in comunitá ed in ospedale: uno studio retrospettivo in un ospedale regionale. Nota IIII: Aspetti microbiologici.

A retrospective study was made of all blood cultures performed over a 40-month period at the Ivrea-Castellamonte Hospital (Turin, Italy). A total of 4386 vials from 619 patients were examined. There were 619 positive vials (14.1%) from 131 patients (21.2%) corresponding to 145 bacteremia episodes, including 129 monomicrobial (89%) and 16 polymicrobial (11%). Ten patients (1.6%) had more than one episode. There were 73 polluted vials (1.7%). A total of 165 microorganism were isolated: Gram-positive (52.7%) and Gram-negative (46%) bacteria, and mycetes (1.2%), anaerobic flora (9.7%). The predominant families were: Enterobacteriaceae (29.5%), Micrococcaceae (27.3%), Pseudomonadaceae (4.8%), Bacteroidaceae (4.8%) and Streptococcus "Genus" (18.8%). The species frequencies were: Escherichia coli (20%), Staphylococcus aureus (15.8%), Enterococcus (8.5%), Staphylococcus epidermidis (7.3%), Pseudomonas aeruginosa (4.8%), Proteus mirabilis (4.2%), Brucella spp. (2.4%), Bacteroides fragilis, Streptococcus bovis e Propionibacterium acnes (1.8%). These findings are compared with those published in the Italian and international literature. Stress is laid on periodical review of the isolations from samples of this kind as a useful aid towards the diagnosis and treatment of hospital infections, and in their monitoring and epidemiological evaluation.

[Isolation of anaerobes during a 30-month observation at a hospital microbiology laboratory]. / Isolamento di anaerobi in trenta mesi di osservazione presso un Laboratorio di Microbiologia Ospedaliero.

The authors evaluate retrospectively the results obtained from the research of anaerobial bacteria on 1313 samples received at the Microbiology Laboratory of the "Ospedale Civile di Ivrea" over a period of 31 months (6/1/86-12/31/88). From this evaluation, high percentages of detection of anaerobic bacteria are emerging in the following infections: appendiculare abscesses (60%), intestinal operations (71%), wounds (57%), tubovarian abscesses (100%), as well as thoracic empyema (50%). Also relevant are the isolations from skin and subcutaneous tissues: breast infections (50%) preputial infections (60%), perineal and perirectal abscesses (60%). The incident of anaerobic bacteria in bacteriemia is 17%. The most representative anaerobic bacteria group are: Bacteroides spp. (56%), Peptostreptococcus spp. (12%), Propionibacterium spp. (9%), Fusobacterium spp. (7%) Clostridium spp. (6%), Veillonella spp. and Eubacterium spp. (3%). In the intraabdominal infections prevails the Bacteroides group, particularly fragilis species, while in the skin and subcutaneous infections prevails the Peptostreptococcus group.

[Clinical case of mycetoma caused by Scedosporium apiospermum]. / Segnalazione di un caso clinico di micetoma da Scedosporium apiospermum.

The authors report a case of mycetoma from Scedosporium apiospermum in a 19 years old patient affected by adult's CGD. They emphasize the importance of mycetes' identification from clinical specimens' isolates, to consent a correct interpretation of the bacteriological result from physician.

[Antibiotic resistance at a hospital environment. Observations from 1980 to 1986]. / Antibioticoresistenza in ambiente ospedaliero. Osservazioni dal 1980 al 1986.

A total of 1659 bacteria Strains were examined for susceptibility to different drugs by the Kirby-Bauer method. The isolates came from the General Medicine ward of Castellamonte's hospital (USSL 40). The results were retrospectively studied and statistically elaborated. The study lasted from 2 to 7 years depending on the antibiotic considered. The isolates included: Escherichia coli, Klebsiella spp., Serratia spp., Citrobacter spp., Proteus mirabilis, Proteus IND+, Pseudomonas aeruginosa, Pseudomonas spp., Staphylococcus aureus, Staphylococcus spp., Streptococcus faecalis. Penicillines, Cefalosporines, Aminoglycosides, Quinolones, Tetraciclines, Nitrofurantoin, Macrolides, Rifampins, Lincosides and peptide antibiotics were tested. The results of this study can be useful for the choice of the antibiotics in non-specific therapy of infectious diseases and show the frequency of isolation of resistant strains from hospitalized patients. Furthermore it would be important to constitute a regional-epidemiological centre of Infectious Diseases.